| Ridgeway Pediatrics, Family & Dental Practice | |
|
755 Us Highway 21 S Ridgeway SC 29130-6844 | |
| (803) 337-2920 | |
| (803) 337-3010 |
| Full Name | Ridgeway Pediatrics, Family & Dental Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 755 Us Highway 21 S, Ridgeway, South Carolina |
| Authorized Official Name and Position | Delgado Cantave (CEO) |
| Authorized Official Contact | 8037335969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridgeway Pediatrics, Family & Dental Practice Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Ridgeway Pediatrics, Family & Dental Practice 755 Us Highway 21 S Ridgeway SC 29130-6844 Ph: (803) 337-2920 |
| NPI Number | 1760703250 |
|---|---|
| Provider Enumeration Date | 06/18/2010 |
| Last Update Date | 03/19/2021 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20101013000489 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760703250 | NPI | - | NPPES |
| CBP018 | Medicaid | SC | |
| FQC031 | Medicaid | SC | |
| FQC176 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |