MEDICARE: METROLYNA HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	MD20627	SC
2	261QP2300X	Primary Care Clinic/Center	20627	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780761684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROLYNA HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 49089
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0073
Country	:	US
Telephone Number	:	803-273-4018
Fax Number	:	803-273-4023

Provider Business Practice Location Address
First Line	:	209 SOUTH COLLEGE STREET
Second Line	:
City	:	HEATH SPRINGS
State	:	SC
Zip	:	29058
Country	:	US
Telephone Number	:	803-273-4018
Fax Number	:	803-273-4023

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	IFEDIORA FOSTER AFULUKWE
Credential	:	MD
Telephone Number	:	803-273-4018

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/01/2016

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