| Testing Supplier | |
|
4100 N Main St Ste 104 Columbia SC 29203-5800 | |
| (843) 229-5626 | |
| (803) 814-2520 |
| Full Name | Testing Supplier |
|---|---|
| Speciality | Clinic/center |
| Location | 4100 N Main St Ste 104, Columbia, South Carolina |
| Authorized Official Name and Position | Chirvella Louise Terry (TECHNICIAN) |
| Authorized Official Contact | 8432295626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Testing Supplier 4100 N Main St Ste 104 Columbia SC 29203-5800 Ph: (843) 229-5626 | Testing Supplier 4100 N Main St Ste 104 Columbia SC 29203-5800 Ph: (843) 229-5626 |
| NPI Number | 1497249874 |
|---|---|
| Provider Enumeration Date | 06/19/2018 |
| Last Update Date | 06/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497249874 | NPI | - | NPPES |
| 119254555 | Other | SC | CONTRACTOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 119254555 (South Carolina) | Primary |
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