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8906 Two Notch Rd Columbia SC 29223-6366 | |
(843) 584-4354 | |
(803) 254-3678 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 8906 Two Notch Rd, Columbia, South Carolina |
Authorized Official Name and Position | Tony Megna (CEO) |
Authorized Official Contact | 8032543676 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8906 Two Notch Rd Columbia SC 29223-6366 Ph: (803) 254-3676 | 8906 Two Notch Rd Columbia SC 29223-6366 Ph: (843) 584-4354 |
NPI Number | 1346088879 |
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Provider Enumeration Date | 07/18/2024 |
Last Update Date | 09/09/2024 |
Identifier | Type | State | Issuer |
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1346088879 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (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 | |