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100 Palmetto Health Parkway Suite 220 Columbia SC 29212-1755 | |
(803) 749-0693 | |
(803) 749-3986 |
Full Name | |
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Speciality | Family Medicine |
Location | 100 Palmetto Health Parkway, Columbia, South Carolina |
Authorized Official Name and Position | Darrell C Coven (DIRECTOR, AMBULATORY SERVICES, FIN.) |
Authorized Official Contact | 8032967301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7305 | 100 Palmetto Health Parkway Suite 220 Columbia SC 29212-1755 Ph: (803) 749-0693 |
NPI Number | 1851642458 |
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Provider Enumeration Date | 09/24/2012 |
Last Update Date | 06/29/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851642458 | NPI | - | NPPES |
GP6103 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (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 | |