| Waverly Family Practice | |
|
1228 Harden St Ste.c Columbia SC 29204-1800 | |
| (803) 748-1181 | |
| (803) 748-1185 |
| Full Name | Waverly Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1228 Harden St, Columbia, 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 |
|---|---|
| Waverly Family Practice Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Waverly Family Practice 1228 Harden St Ste.c Columbia SC 29204-1800 Ph: (803) 748-1181 |
| NPI Number | 1053622050 |
|---|---|
| Provider Enumeration Date | 06/24/2010 |
| Last Update Date | 02/03/2022 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20101013000254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053622050 | NPI | - | NPPES |
| CBP018 | Medicaid | SC | |
| FQC031 | Medicaid | SC | |
| FQC164 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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