MEDICARE: MIDLANDS MEDICAL WELLNESS CENTER, 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	261Q00000X	Clinic/Center	22453	SC

General Provider Information

NPI Number	:	1649613621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLANDS MEDICAL WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	205 WATER HICKORY WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SPRINGTREE DR
Second Line	:	SUITE 200
City	:	COLUMBIA
State	:	SC
Zip	:	29223-8614
Country	:	US
Telephone Number	:	803-223-9328
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JANDRETTE RHOE
Credential	:	MD
Telephone Number	:	803-223-9328

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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