Healthcare Provider Details

I. General information

NPI: 1215323969
Provider Name (Legal Business Name): INJURY MEDICAL CENTERS OF SOUTH CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SHALLOW BROOK DR
COLUMBIA SC
29223-8110
US

IV. Provider business mailing address

208 SHALLOW BROOK DR
COLUMBIA SC
29223-8110
US

V. Phone/Fax

Practice location:
  • Phone: 434-444-2705
  • Fax:
Mailing address:
  • Phone: 434-444-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31618
License Number StateSC

VIII. Authorized Official

Name: DR. JOHN F MATTEI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-786-0559