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146 N Hospital Drive Suite 350 West Columbia SC 29169 | |
| (803) 791-2985 | |
| (803) 936-8042 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 146 N Hospital Drive, West Columbia, South Carolina |
| Authorized Official Name and Position | Melinda P Kruzner (CFO & SR. VP) |
| Authorized Official Contact | 8037912000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
146 N Hospital Drive Suite 350 West Columbia SC 29169 Ph: (803) 791-2985 | 146 N Hospital Drive Suite 350 West Columbia SC 29169 Ph: (803) 791-2985 |
| NPI Number | 1962435750 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 05/25/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962435750 | NPI | - | NPPES |
| GP1295 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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