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3010 Farrow Rd Suite 300 Columbia SC 29203-7607 | |
(803) 434-1210 | |
(803) 434-1212 |
Full Name | |
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Speciality | Internal Medicine - Geriatric Medicine |
Location | 3010 Farrow Rd, Columbia, South Carolina |
Authorized Official Name and Position | Thomas Wayne Jackson (MEDICAL DIRECTOR) |
Authorized Official Contact | 8034341210 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3010 Farrow Rd Suite 300 Columbia SC 29203-7607 Ph: (803) 434-1210 | 3010 Farrow Rd Suite 300 Columbia SC 29203-7607 Ph: (803) 434-1210 |
NPI Number | 1962471946 |
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Provider Enumeration Date | 03/14/2006 |
Last Update Date | 03/04/2008 |
Identifier | Type | State | Issuer |
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1962471946 | NPI | - | NPPES |
GP1537 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0300X | Internal Medicine - Geriatric Medicine | (South Carolina) | Primary |
282NC0060X | General Acute Care Hospital - Critical Access | (South Carolina) | Secondary |
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 | |