| Raddon Llc | |
|
114 Gateway Corporate Blvd Ste 220 Columbia SC 29203-9785 | |
| (770) 335-9797 | |
| (803) 849-8247 |
| Full Name | Raddon Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 114 Gateway Corporate Blvd Ste 220, Columbia, South Carolina |
| Authorized Official Name and Position | Roger N Phillips (MANAGER) |
| Authorized Official Contact | 7703359797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raddon Llc 114 Gateway Corporate Blvd Ste 220 Columbia SC 29203-9785 Ph: (770) 335-9797 | Raddon Llc 114 Gateway Corporate Blvd Ste 220 Columbia SC 29203-9785 Ph: (770) 335-9797 |
| NPI Number | 1861972853 |
|---|---|
| Provider Enumeration Date | 08/18/2018 |
| Last Update Date | 06/23/2022 |
| Medicare PECOS PAC ID | 1456744242 |
|---|---|
| Medicare Enrollment ID | O20220129000271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861972853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Juanita Linn Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770071573 PECOS PAC ID: 5890040158 Enrollment ID: I20210324000953 |
| Provider Name | Evelynn M Pennington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053952457 PECOS PAC ID: 6406249242 Enrollment ID: I20220131001825 |
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