| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
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