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4311 Hard Scrabble Rd Columbia SC 29229-9422 | |
(803) 419-6334 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 4311 Hard Scrabble Rd, Columbia, South Carolina |
Authorized Official Name and Position | Darrell C. Coven (DIRECTOR, AMBULATORY SRVC-FINANCE) |
Authorized Official Contact | 8032967301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7305 | 4311 Hard Scrabble Rd Columbia SC 29229-9422 Ph: (803) 419-6334 |
NPI Number | 1063701480 |
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Provider Enumeration Date | 04/06/2011 |
Last Update Date | 08/17/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063701480 | NPI | - | NPPES |
GP5675 | Medicaid | SC |
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 | |