NPI 1336684851

Northlake Family Practice

Organisation Exclusive Provider Organization Columbia, SC

Practice location

Address: 115 Blarney Dr Suite 101 C, Columbia, SC 29223-6291
Phone: (803) 419-5131

Authorised official

Name: Robert Ramos
Title: President / Owner
Phone: (803) 622-3559

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 19001 (SC)

Other Exclusive Provider Organization providers in South Carolina →

Registry record

NPI: 1336684851
Entity type: Organization
NPI issued: 20 Dec 2016
Record last updated: 20 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.