| Hartvigsen Family Medicine | |
|
3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 | |
| (803) 736-0731 | |
| (803) 736-0753 |
| Full Name | Hartvigsen Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 3000 Ne Medical Park, Columbia, South Carolina |
| Authorized Official Name and Position | Robert E Hartvigsen (OWNER) |
| Authorized Official Contact | 8037360731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hartvigsen Family Medicine 3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 Ph: (803) 736-0731 | Hartvigsen Family Medicine 3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 Ph: (803) 736-0731 |
| NPI Number | 1861504441 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 7315944147 |
|---|---|
| Medicare Enrollment ID | O20061108000545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861504441 | NPI | - | NPPES |
| GP4509 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 13110 (South Carolina) | Primary |
| Provider Name | Robert E Hartvigsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386604601 PECOS PAC ID: 9032138524 Enrollment ID: I20051114001007 |
| Provider Name | Linda S Shealy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083858708 PECOS PAC ID: 7618028085 Enrollment ID: I20090624000504 |
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