MEDICARE: GREATER COLUMBIA OB-GYN, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	8219	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154309144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER COLUMBIA OB-GYN, P.A.

Provider Business Mailing Address
First Line	:	1301 TAYLOR ST
Second Line	:	SUITE 3L
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2942
Country	:	US
Telephone Number	:	803-252-0470
Fax Number	:	803-252-0611

Provider Business Practice Location Address
First Line	:	1301 TAYLOR ST
Second Line	:	SUITE 3L
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2942
Country	:	US
Telephone Number	:	803-252-0470
Fax Number	:	803-252-0611

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAHMOUD MOSTAFA
Credential	:	M.D.
Telephone Number	:	803-252-0470

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	09/18/2008

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