institution
74 Polo Road, Llc
Multi-Specialty Clinic/Center in Columbia, South Carolina
NPI 1093262628

74 Polo Road, Llc is a Multi-Specialty Clinic/Center based in Columbia, SC and is specialized in Multi-Specialty. 74 Polo Road, Llc practices in Columbia, SC. The NPI Number for 74 Polo Road, Llc is 1093262628 and holds a License No. 20381 (South Carolina).

The current practice location address for 74 Polo Road, Llc is 74 Polo Rd, Columbia, SC and can be reached out via phone at 803-419-7780 and via fax at 803-419-7781.

Location: 74 Polo Rd, Columbia, SC, 29223-2806
institution
Provider Profile Details
NPI Number
1093262628
Provider Name
74 Polo Road, Llc
Credential
Provider Entity Type
Organization
Address
74 Polo Rd, Columbia, SC, 29223-2806
Phone Number
803-419-7780
Fax Number
803-419-7781
Provider Enumeration Date
09/01/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
PENDING 01 SC MEDICARE AND MEDICAID PENDING
institution
Provider Business Practice Location Address Details
Address
74 Polo Rd
City
State
Zip
29223-2806
Phone Number
803-419-7780
Fax Number
803-419-7781
person
Provider Business Mailing Address Details
Address
74 Polo Rd
City
State
Zip
29223-2806
Phone Number
803-419-7780
Fax Number
803-419-7781
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Multi-Specialty
Taxonomy
License No.
20381 (South Carolina)
Definition
Definition to come...
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