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NPI Code Detail

MEDICARE: COLUMBIA MEDICAL GROUP

MEDICARE: COLUMBIA MEDICAL GROUP
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
1207R00000XInternal Medicine Physician14628SC

Other Identifiers

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

General Provider Information

NPI Number : 1174506497
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLUMBIA MEDICAL GROUP
Provider Business Mailing Address
First Line : 4540 TRENHOLM RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29206-4462
Country : US
Telephone Number : 803-790-4700
Fax Number : 803-790-6130
Provider Business Practice Location Address
First Line : 4540 TRENHOLM RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29206-4462
Country : US
Telephone Number : 803-790-4700
Fax Number : 803-790-6130
Authorized Official
Title or Position : OFFICE MANAGER
Name : MR. DAVID WILLIAM GAVIN
Credential :
Telephone Number : 803-790-4700
Provider Enumeration Date : 11/21/2005
Last Update Date : 10/16/2007

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1043279854 — DR. BRADLEY W WORD MD
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1225098478 — DR. STACIE K MOORE-BOWENS MD
Practice Location Address:
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Practice Fax: 803-790-6130

Directions to “COLUMBIA MEDICAL GROUP ” Practice Location

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