COLONIAL FAMILY PRACTICE & AMBULATORY CARE CENTER NPI 1902229214

NPI Information

NPI: 1902229214
Provider Name: COLONIAL FAMILY PRACTICE & AMBULATORY CARE CENTER

Doing Business As: COLONIAL FAMILY PRACTICE COLUMBIA

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 42D2010560

Address:
4700 FOREST DR
COLUMBIA, SC
ZIP 29206
Phone: (803) 773-5227
Get Directions

COLONIAL FAMILY PRACTICE & AMBULATORY CARE CENTER is a family medicine in Columbia, SC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. COLONIAL FAMILY PRACTICE & AMBULATORY CARE CENTER NPI is 1902229214. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Colonial Family Practice Columbia.

The provider's business location address is:

4700 FOREST DR
COLUMBIA, SC
ZIP 29206
Phone: (803) 773-5227

The provider's authorized official is Stephanie Knight Disher .
The authorized official title is Credentialing Manager and has the following contact phone number (803) 773-5227.

The CLIA number assigned to this NPI record is 42D2010560 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/23/2014 and was last updated on 3/22/2021.

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	207P00000X	Emergency Medicine		28747	SOUTH CAROLINA	No
2	261QE0800X	Clinic/Center	Endoscopy	17676	SOUTH CAROLINA	No
3	261QH0100X	Clinic/Center	Health Service			No
4	261QM1200X	Clinic/Center	Magnetic Resonance Imaging (MRI)	07-6916 GLENN GOUDY	SOUTH CAROLINA	No
5	363A00000X	Physician Assistant				No
6	363L00000X	Nurse Practitioner				No
7	363LF0000X	Nurse Practitioner	Family			No
8	207Q00000X	Family Medicine		25518	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	GP3564	MEDICAID	SOUTH CAROLINA

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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