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21 Gateway Corners Park Ste 101 Columbia SC 29203-8906 | |
(803) 419-4949 | |
(803) 419-6445 |
Full Name | |
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Speciality | Family Medicine |
Location | 21 Gateway Corners Park Ste 101, Columbia, South Carolina |
Authorized Official Name and Position | Jeffrey Brillhart (SENIOR VP/CFO) |
Authorized Official Contact | 8037912967 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 6069 West Columbia SC 29171-6069 Ph: () - | 21 Gateway Corners Park Ste 101 Columbia SC 29203-8906 Ph: (803) 419-4949 |
NPI Number | 1821696949 |
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Provider Enumeration Date | 10/12/2020 |
Last Update Date | 01/06/2025 |
Identifier | Type | State | Issuer |
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1821696949 | NPI | - | NPPES |
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 | |