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NPI Code Detail

MEDICARE: ADVANTAGE MEDICAL GROUP, LLC

MEDICARE: ADVANTAGE MEDICAL GROUP, 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
1173000000XLegal Medicine

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1613535OTHERDHEC

General Provider Information

NPI Number : 1548692478
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANTAGE MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : 9153-C TWO NOTCH ROAD
Second Line :
City : COLUMBIA
State : SC
Zip : 29223
Country : US
Telephone Number : 803-546-1170
Fax Number :
Provider Business Practice Location Address
First Line : 9153 TWO NOTCH RD STE C
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-5853
Country : US
Telephone Number : 803-546-1170
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. TROY D BELTON
Credential :
Telephone Number : 803-546-1170
Provider Enumeration Date : 08/02/2013
Last Update Date : 08/02/2013

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Directions to “ADVANTAGE MEDICAL GROUP, LLC ” Practice Location

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