MEDICARE: SPRINGDALE FAMILY PRACTICE

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	261QP2300X	Primary Care Clinic/Center	SC9312	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

General Provider Information

NPI Number	:	1912065327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGDALE FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	3316 PLATT SPRINGS RD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-2247
Country	:	US
Telephone Number	:	803-796-1522
Fax Number	:	803-794-7061

Provider Business Practice Location Address
First Line	:	3316 PLATT SPRINGS RD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-2247
Country	:	US
Telephone Number	:	803-796-1522
Fax Number	:	803-794-7061

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN ROBERT DUNN III
Credential	:	M.D.
Telephone Number	:	803-796-1521

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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Directions to “SPRINGDALE FAMILY PRACTICE ” Practice Location

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