MEDICARE: POLLOCK PSYCHIATRY LLC

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	261QM0850X	Adult Mental Health Clinic/Center	28154	SC

General Provider Information

NPI Number	:	1336387778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLLOCK PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	PO BOX 291563
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-0027
Country	:	US
Telephone Number	:	803-563-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 BELLE GROVE CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8906
Country	:	US
Telephone Number	:	803-422-6765
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	RALPH C POLLOCK
Credential	:	MD
Telephone Number	:	803-563-8845

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	11/16/2017

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