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2719 Middleburg Dr Suite 201 Columbia SC 29204-2414 | |
(803) 256-6828 | |
(803) 256-6827 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 2719 Middleburg Dr, Columbia, South Carolina |
Authorized Official Name and Position | Yohannes Negash (PRESIDENT) |
Authorized Official Contact | 8032566828 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2719 Middleburg Dr Suite 201 Columbia SC 29204-2414 Ph: (803) 256-6828 | 2719 Middleburg Dr Suite 201 Columbia SC 29204-2414 Ph: (803) 256-6828 |
NPI Number | 1265440705 |
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Provider Enumeration Date | 08/03/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265440705 | NPI | - | NPPES |
GP3800 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (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 | |