Healthcare Provider Details

I. General information

NPI: 1548147226
Provider Name (Legal Business Name): MEDICAL ADVANTAGE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 LINCOLN ST STE 100
COLUMBIA SC
29201-2383
US

IV. Provider business mailing address

1812 LINCOLN ST STE 100
COLUMBIA SC
29201-2383
US

V. Phone/Fax

Practice location:
  • Phone: 877-404-1271
  • Fax:
Mailing address:
  • Phone: 877-404-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL RODRIGUES
Title or Position: DIRECTOR
Credential: MD
Phone: 877-404-1271