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General NPI Number Information
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NPI Number | 1447532635
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Entity Type | Organization
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Legal Business Name | IRMO MEDICAL CENTER
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 120 VAN DER HORST DR
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 843-610-8206
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Fax |
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Provider Business Mailing Address
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Address Line | 120 VAN DER HORST DR
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JOHN WEBB
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Credential | DC, MBA
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Telephone | 843-610-8206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25966
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License Number State | SC
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