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612 St Andrews Rd. Ste 2 Columbia SC 29210-2921 | |
(803) 386-8684 | |
(803) 386-8684 |
Full Name | |
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Speciality | Family Medicine |
Location | 612 St Andrews Rd., Columbia, South Carolina |
Authorized Official Name and Position | Kimberly Shirk (PHYSCIAN ASSISTANT) |
Authorized Official Contact | 8033868684 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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612 Saint Andrews Rd Ste 2 Columbia SC 29210-5120 Ph: (803) 386-8684 | 612 St Andrews Rd. Ste 2 Columbia SC 29210-2921 Ph: (803) 386-8684 |
NPI Number | 1669981429 |
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Provider Enumeration Date | 09/25/2017 |
Last Update Date | 06/16/2018 |
Identifier | Type | State | Issuer |
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1669981429 | NPI | - | NPPES |
1164683926 | Other | SC | COMMERCIAL |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 2504 (South Carolina) | 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 | |