74 POLO ROAD LLC NPI 1093262628

NPI Information

NPI: 1093262628
Provider Name: 74 POLO ROAD, LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
74 POLO RD
COLUMBIA, SC
ZIP 29223
Phone: (803) 419-7780
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74 POLO ROAD, LLC is a multi-specialty clinic center in Columbia, SC. 74 POLO ROAD, LLC NPI is 1093262628. The provider is registered as an organization entity type.

The provider's business location address is:

74 POLO RD
COLUMBIA, SC
ZIP 29223-806
Phone: (803) 419-7780
Fax: (803) 419-7781

The provider's authorized official is Jeff Lehrich .
The authorized official title is Executive Director and has the following contact phone number (480) 235-7788.

The enumeration date for this NPI number is 9/1/2016 and was last updated on 9/1/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty	20381	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	PENDING	OTHER	SOUTH CAROLINA	MEDICARE AND MEDICAID PENDING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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