| Eventus WH Southeast - South Carolina, LLC | |
|
2 Office Park Ct Ste 103 Columbia SC 29223-5948 | |
| (855) 743-2247 | |
| Not Available |
| Full Name | Eventus WH Southeast - South Carolina, LLC |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2 Office Park Ct Ste 103, Columbia, South Carolina |
| Authorized Official Name and Position | George Hall (OWNER) |
| Authorized Official Contact | 8557432247 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eventus WH Southeast - South Carolina, LLC Po Box 1431 Dept 417 Charlotte NC 28201-1431 Ph: (855) 742-2247 | Eventus WH Southeast - South Carolina, LLC 2 Office Park Ct Ste 103 Columbia SC 29223-5948 Ph: (855) 743-2247 |
| NPI Number | 1790503571 |
|---|---|
| Provider Enumeration Date | 09/30/2024 |
| Last Update Date | 09/30/2024 |
| Certification Date | 09/30/2024 |
| Medicare PECOS PAC ID | 5698201523 |
|---|---|
| Medicare Enrollment ID | O20241216000848 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790503571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Secondary |
| 363A00000X | Physician Assistant | () | Secondary |
| 363L00000X | Nurse Practitioner | () | Primary |
| Provider Name | Bruce H Lobitz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780663914 PECOS PAC ID: 4981500725 Enrollment ID: I20031211000290 |
| Provider Name | Jordan Rhodes Sauls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932599206 PECOS PAC ID: 9133432594 Enrollment ID: I20150715000199 |
| Provider Name | Sandeep B Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184631533 PECOS PAC ID: 2668476961 Enrollment ID: I20191015000124 |
| Provider Name | Nickey Lashae Dimery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407455363 PECOS PAC ID: 3173937083 Enrollment ID: I20210203002026 |
| Provider Name | Shantise Byrd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871172254 PECOS PAC ID: 4587073382 Enrollment ID: I20210507000226 |
| Provider Name | Adam Culbertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245849835 PECOS PAC ID: 5799104154 Enrollment ID: I20210728003541 |
| Provider Name | Sharena C Gamble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932825577 PECOS PAC ID: 2668844929 Enrollment ID: I20230214002822 |
| Provider Name | Hosea Kibet Koech |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760173991 PECOS PAC ID: 6608236203 Enrollment ID: I20230713004125 |
| Provider Name | Solomon Wesseh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912397142 PECOS PAC ID: 4789924341 Enrollment ID: I20230823000355 |
| Provider Name | Richzer Vincent Chu Villamor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851161830 PECOS PAC ID: 4587008917 Enrollment ID: I20241114004420 |
| Provider Name | Ivey Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063932473 PECOS PAC ID: 8729205505 Enrollment ID: I20251002000648 |
| Provider Name | Tabitha Alford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316394406 PECOS PAC ID: 4789977000 Enrollment ID: I20251212002459 |
| Provider Name | Alexandria Mcneill |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558847053 PECOS PAC ID: 9133463516 Enrollment ID: I20251213000111 |
| Provider Name | Simon Garmo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235742024 PECOS PAC ID: 1052797214 Enrollment ID: I20251215000780 |
| Provider Name | Robert Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861576738 PECOS PAC ID: 1951373745 Enrollment ID: I20251218004146 |
| Provider Name | Larreasha Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811505803 PECOS PAC ID: 6204253958 Enrollment ID: I20260107002941 |
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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 |
Five Points Pediatrics Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1228 Harden St Ste B, Columbia, SC 29204 Phone: 803-748-7002 Fax: 803-252-5259 |