Healthcare Provider Details

I. General information

NPI: 1932305497
Provider Name (Legal Business Name): COLUMBIA CENTRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 MEDICAL DR
COLUMBIA SC
29203-6504
US

IV. Provider business mailing address

3511 MEDICAL DR
COLUMBIA SC
29203-6504
US

V. Phone/Fax

Practice location:
  • Phone: 803-771-0518
  • Fax: 803-771-7286
Mailing address:
  • Phone: 803-771-0518
  • Fax: 803-771-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number78092
License Number StateSC

VIII. Authorized Official

Name: MRS. PAM POSTON
Title or Position: FACILITY ADMINTRATOR
Credential:
Phone: 803-771-0518