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1655 Bernardin Ave Suite 110 Columbia SC 29204-2039 | |
(803) 254-4056 | |
(803) 254-4120 |
Full Name | |
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Speciality | Internal Medicine |
Location | 1655 Bernardin Ave, Columbia, South Carolina |
Authorized Official Name and Position | Jeremy W. Whitaker (MANAGER) |
Authorized Official Contact | 8038654798 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 60496 Charlotte NC 28260-0496 Ph: (803) 254-4056 | 1655 Bernardin Ave Suite 110 Columbia SC 29204-2039 Ph: (803) 254-4056 |
NPI Number | 1518087287 |
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Provider Enumeration Date | 03/29/2007 |
Last Update Date | 03/07/2008 |
Identifier | Type | State | Issuer |
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1518087287 | NPI | - | NPPES |
GP4662 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal 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 | |