Northlake Family Medical Practice | |
3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 | |
(803) 419-5131 | |
(803) 419-5130 |
Full Name | Northlake Family Medical Practice |
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Speciality | Family Medicine |
Location | 3000 Ne Medical Park, Columbia, South Carolina |
Authorized Official Name and Position | Reginald L Parker (OWNER) |
Authorized Official Contact | 8034195131 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Northlake Family Medical Practice 3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 Ph: (803) 419-5131 | Northlake Family Medical Practice 3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 Ph: (803) 419-5131 |
NPI Number | 1003928680 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 10/16/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003928680 | NPI | - | NPPES |
GP4438 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 14862 (South Carolina) | Primary |
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 | |