| Northeast Family Practice | |
|
3000 Ne Medical Park Suite 209 Columbia SC 29223-6251 | |
| (803) 736-6262 | |
| (803) 699-1934 |
| Full Name | Northeast Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 3000 Ne Medical Park, Columbia, South Carolina |
| Authorized Official Name and Position | Darrell C Coven (FINANCE DIRECTOR OF BUSINESS DEV.) |
| Authorized Official Contact | 8032967301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Family Practice Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7313 | Northeast Family Practice 3000 Ne Medical Park Suite 209 Columbia SC 29223-6251 Ph: (803) 736-6262 |
| NPI Number | 1659316743 |
|---|---|
| Provider Enumeration Date | 06/20/2006 |
| Last Update Date | 12/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659316743 | NPI | - | NPPES |
| GP0039 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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