Healthcare Provider Details

I. General information

NPI: 1538078100
Provider Name (Legal Business Name): FLO & GLO IV WELLNESS LOUNGE - COLUMBIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 TOWN CENTER PL STE 13
COLUMBIA SC
29229-7964
US

IV. Provider business mailing address

471 TOWN CENTER PL STE 13
COLUMBIA SC
29229-7964
US

V. Phone/Fax

Practice location:
  • Phone: 803-550-9098
  • Fax:
Mailing address:
  • Phone: 803-550-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES PATRICK HEINTZMAN
Title or Position: CHIEF OPERATING OFFICER
Credential: COO
Phone: 912-432-2346