Healthcare Provider Details

I. General information

NPI: 1255945754
Provider Name (Legal Business Name): ESCOBEDO ADVANCED HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SPARKLEBERRY CROSSING RD STE 200
COLUMBIA SC
29229-8639
US

IV. Provider business mailing address

121 SPARKLEBERRY CROSSING RD STE 200
COLUMBIA SC
29229-8639
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-2167
  • Fax: 803-788-4165
Mailing address:
  • Phone: 803-788-2167
  • Fax: 803-788-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ESCOBEDO
Title or Position: OWNER
Credential:
Phone: 803-319-5457