| Lake Ridge Neurological | |
|
Suite B 103 Omni Drive Seneca SC 29672-9448 | |
| (864) 885-9866 | |
| (864) 888-8307 |
| Full Name | Lake Ridge Neurological |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | Suite B 103 Omni Drive, Seneca, South Carolina |
| Authorized Official Name and Position | Orlando Arthur Ricalde (PRESIDENT) |
| Authorized Official Contact | 8648859866 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Ridge Neurological Suite B 103 Omni Drive Seneca SC 29672-9448 Ph: (864) 885-9866 | Lake Ridge Neurological Suite B 103 Omni Drive Seneca SC 29672-9448 Ph: (864) 885-9866 |
| NPI Number | 1063486363 |
|---|---|
| Provider Enumeration Date | 02/14/2006 |
| Last Update Date | 10/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063486363 | NPI | - | NPPES |
| GP1724 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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