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190 Parkridge Dr Suite 220 Columbia SC 29212-1747 | |
(803) 296-7304 | |
(803) 296-7329 |
Full Name | |
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Speciality | Family Medicine |
Location | 190 Parkridge Dr, Columbia, South Carolina |
Authorized Official Name and Position | Darrell C Coven (DIRECTOR OF BUSINESS DEV., FINANCE) |
Authorized Official Contact | 8032967301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7313 | 190 Parkridge Dr Suite 220 Columbia SC 29212-1747 Ph: (803) 296-7304 |
NPI Number | 1205867785 |
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Provider Enumeration Date | 07/05/2006 |
Last Update Date | 12/27/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205867785 | NPI | - | NPPES |
GP3809 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
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 | |