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General NPI Number Information
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NPI Number | 1255945754
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Entity Type | Organization
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Legal Business Name | ESCOBEDO ADVANCED HEALTHCARE SOLUTIONS LLC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 121 SPARKLEBERRY CROSSING RD STE 200
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City | COLUMBIA
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State | SC
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Zip | 29229-8639
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Country | US
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Telephone | 803-788-2167
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Fax | 803-788-4165
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Provider Business Mailing Address
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Address Line | 121 SPARKLEBERRY CROSSING RD STE 200
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City | COLUMBIA
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State | SC
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Zip | 29229-8639
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Country | US
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Telephone | 803-788-2167
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Fax | 803-788-4165
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ESCOBEDO
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Credential |
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Telephone | 803-319-5457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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