| |
131 Wildewood Park Dr Columbia SC 29223-4300 | |
(803) 999-4030 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 131 Wildewood Park Dr, Columbia, South Carolina |
Authorized Official Name and Position | Jody Addair (CLINICAL OPS PROJECT COORD.) |
Authorized Official Contact | 3175560017 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
124 Allawood Ct Simpsonville SC 29681-6207 Ph: (864) 501-0751 | 131 Wildewood Park Dr Columbia SC 29223-4300 Ph: (803) 999-4030 |
NPI Number | 1184498628 |
---|---|
Provider Enumeration Date | 11/14/2023 |
Last Update Date | 11/22/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184498628 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (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 | |