The Medical Place Family Practice, P.A.
Clinic/Center, Primary Care in West Columbia, SC. Organization (NPI-2).
NPI number1760633960
StatusActive
Last updated in NPPESOct 6, 2008
Details
- NPI
- 1760633960
- Entity type
- Organization (NPI-2)
- Legal business name
- The Medical Place Family Practice, P.A.
- Organization subpart
- No
- Enumeration date
- Oct 6, 2008
- Last updated
- Oct 6, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | 24923 | SC | Yes |
Practice location
3020 Sunset BlvdSuite 101
West Columbia, SC 29169-3493
Phone 803-791-5680
Mailing address
212 Cherry Grove DrWest Columbia, SC 29170-3070
Phone 803-358-9843 · Fax 803-358-9843
Authorized official
Tasha Matthews Boone
President
8033589843
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