| Springwood Lake Primary Care, Llc | |
|
1721 Horseshoe Dr Columbia SC 29223-6281 | |
| (803) 626-0600 | |
| (803) 626-0700 |
| Full Name | Springwood Lake Primary Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1721 Horseshoe Dr, Columbia, South Carolina |
| Authorized Official Name and Position | Stephen F Serbin (PRESIDENT) |
| Authorized Official Contact | 8036260600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Springwood Lake Primary Care, Llc 1721 Horseshoe Dr Columbia SC 29223-6281 Ph: (803) 626-0600 | Springwood Lake Primary Care, Llc 1721 Horseshoe Dr Columbia SC 29223-6281 Ph: (803) 626-0600 |
| NPI Number | 1841797081 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 8022363977 |
|---|---|
| Medicare Enrollment ID | O20180615002551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841797081 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jennifer G Rice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063690907 PECOS PAC ID: 1658445432 Enrollment ID: I20080926000493 |
| Provider Name | Stephen F Serbin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992715684 PECOS PAC ID: 3375500671 Enrollment ID: I20110425000647 |
| Provider Name | Linda Louise Hundley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750364519 PECOS PAC ID: 9537381850 Enrollment ID: I20180720001533 |
| Provider Name | Jerri N Masanovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366922866 PECOS PAC ID: 6709138175 Enrollment ID: I20181012000730 |
| Provider Name | Caroline Davis White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326479361 PECOS PAC ID: 9234404435 Enrollment ID: I20210203000825 |
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