| Capital Brain Center, Pa | |
|
2800 Bush River Rd Ste 5 Columbia SC 29210-5662 | |
| (803) 551-2900 | |
| (803) 551-2979 |
| Full Name | Capital Brain Center, Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2800 Bush River Rd Ste 5, Columbia, South Carolina |
| Authorized Official Name and Position | Subba M Rao (OWNER) |
| Authorized Official Contact | 8035512900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital Brain Center, Pa Po Box 9426 Columbia SC 29290-9426 Ph: (803) 551-2900 | Capital Brain Center, Pa 2800 Bush River Rd Ste 5 Columbia SC 29210-5662 Ph: (803) 551-2900 |
| NPI Number | 1629106430 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1850491523 |
|---|---|
| Medicare Enrollment ID | O20070710000789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629106430 | NPI | - | NPPES |
| 236177 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 23617 (South Carolina) | Primary |
| Provider Name | Susan C Gentry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891752846 PECOS PAC ID: 5698795367 Enrollment ID: I20051128000434 |
| Provider Name | Subba Rao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518053909 PECOS PAC ID: 4880794460 Enrollment ID: I20070716000632 |
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