Healthcare Provider Details

I. General information

NPI: 1649006032
Provider Name (Legal Business Name): RR DIAGNOSTIC LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 SAINT ANDREWS RD STE B
COLUMBIA SC
29210-4580
US

IV. Provider business mailing address

534 SAINT ANDREWS RD STE B
COLUMBIA SC
29210-4580
US

V. Phone/Fax

Practice location:
  • Phone: 803-489-8777
  • Fax:
Mailing address:
  • Phone: 803-489-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENYFER FOUST
Title or Position: DIRECTOR
Credential:
Phone: 803-489-8777