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3016 Longtown Commons Dr Ste 200 Columbia SC 29229-7849 | |
(803) 314-0500 | |
(803) 314-0501 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3016 Longtown Commons Dr Ste 200, Columbia, South Carolina |
Authorized Official Name and Position | Jeffrey Brillhart (SR VP/CFO) |
Authorized Official Contact | 8037912967 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 6069 West Columbia SC 29171-6069 Ph: () - | 3016 Longtown Commons Dr Ste 200 Columbia SC 29229-7849 Ph: (803) 314-0500 |
NPI Number | 1326640442 |
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Provider Enumeration Date | 11/13/2020 |
Last Update Date | 12/02/2020 |
Medicare PECOS PAC ID | 2567872070 |
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Medicare Enrollment ID | O20210421001619 |
Identifier | Type | State | Issuer |
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1326640442 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
261QR0200X | Clinic/center - Radiology | (* (Not Available)) | Primary |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
Lagniappe Medical Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74 Polo Rd, Columbia, SC 29223 Phone: 803-419-7780 Fax: 803-419-7781 | |