MEDICARE: SPRING VALLEY FAMILY PRACTIC

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	261QM2500X	Medical Specialty Clinic/Center	15409	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205889789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING VALLEY FAMILY PRACTIC

Provider Business Mailing Address
First Line	:	229 LONGTOWN RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8550
Country	:	US
Telephone Number	:	803-419-4949
Fax Number	:	803-419-6445

Provider Business Practice Location Address
First Line	:	229 LONGTOWN RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8550
Country	:	US
Telephone Number	:	803-419-4949
Fax Number	:	803-419-6445

Authorized Official
Title or Position	:	OWNER
Name	:	RUTKUMAR JANI
Credential	:
Telephone Number	:	803-419-4949

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/20/2008

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Directions to “SPRING VALLEY FAMILY PRACTIC ” Practice Location

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