| Innovations Ridgewood | |
|
4801 Monticello Rd Columbia SC 29203-4124 | |
| (803) 714-0266 | |
| (803) 252-1968 |
| Full Name | Innovations Ridgewood |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 4801 Monticello Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Kimberly Tilley (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8043061203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovations Ridgewood Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Innovations Ridgewood 4801 Monticello Rd Columbia SC 29203-4124 Ph: (803) 714-0266 |
| NPI Number | 1427494392 |
|---|---|
| Provider Enumeration Date | 05/17/2013 |
| Last Update Date | 06/24/2026 |
| Certification Date | 06/24/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427494392 | NPI | - | NPPES |
| 4350 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
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