74 POLO ROAD, LLC (NPI# 1093262628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093262628 |
| Entity Type | Organization |
| Organization Name | 74 POLO ROAD, LLC |
| Practice Address |
74 Polo Rd Columbia SC 29223-2806 |
| Practice Telephone | 8034197780 |
| Practice Fax Number | 8034197781 |
| Mailing Telephone | 8034197780 |
| Mailing Fax Number | 8034197781 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | JEFF LEHRICH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4802357788 |
| Is Organization Subpart | Y |
| Parent Organization Name | EVFI POLO ROAD LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
20381 | SC | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MEDICARE AND MEDICAID PENDING | PENDING | 01 |
| Street Address |
74 POLO RD |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29223-2806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700810116 | Andrew James Malinchak | Family Medicine | 74 Polo Rd, Columbia, SC 29223-2806 | 2006-07-10 |
| 1093348518 | Crocodile Pharmacy Services, LLC | Internal Medicine | 74 Polo Rd, Columbia, SC 29223-2806 | 2020-02-13 |
| 1689130734 | Heather Nicole Pastva | Physician Assistant | 74 Polo Rd, Columbia, SC 29223-2806 | 2019-02-13 |
| 1407322167 | Megan Annette Kirkland | Physician Assistant | 74 Polo Rd, Columbia, SC 29223-2806 | 2018-10-22 |
| 1700351285 | Daniela Murphy | Physician Assistant | 74 Polo Rd, Columbia, SC 29223-2806 | 2018-10-10 |
| 1992212385 | Sonya J Arrington | Health Educator | 74 Polo Rd, Columbia, SC 29223-2806 | 2018-01-07 |
| 1023564622 | Lagniappe Medical Clinics, LLC | Family Medicine | 74 Polo Rd, Columbia, SC 29223-2806 | 2016-09-01 |
| 1457361669 | Palmetto Pediatric | Pediatrics | 74 Polo Rd, Columbia, SC 29223-2806 | 2006-08-09 |
| 1538179601 | Teresa N Baggett | Pediatrics | 74 Polo Rd, Columbia, SC 29223-2806 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619522794 | Timothy Drew Edwards | Dentist | 122 N. Brickyard Rd, Columbia, SC 29223 | 2019-08-06 |
| 1861983249 | Southern Pain Specialists | Physical Medicine & Rehabilitation | 115 Blarney Dr Ste 111, Columbia, SC 29223 | 2018-05-22 |
| 1710481452 | Evans Counseling and Consulting, LLC | Social Worker | 120 Wildewood Park Dr Ste A, Columbia, SC 29223 | 2018-03-19 |
| 1750824819 | Marquita Heyward | Counselor | 1 Winsor Cove Suite 303, Columbia, SC 29223 | 2016-11-22 |
| 1578015509 | Carolina Family Pharmacy, LLC | Pharmacy | 9153 Two Notch Road, Columbia, SC 29223 | 2016-10-25 |
| 1225485170 | Lisa Diaz | Occupational Therapy Assistant | 7601 Parlane Rd, Columbia, SC 29223 | 2016-05-20 |
| 1295199859 | Sarah Ann Riley | Nurse Practitioner | Cvs Pharmacy 121 Clemson Rd., Columbia, SC 29223 | 2016-04-11 |
| 1134583214 | Sara Alisha Pound | Behavioral Analyst | 97b Winterberry Ln, Columbia, SC 29223 | 2016-04-05 |
| 1508227653 | Lucy Elvira Vicioso-harris | Counselor | 1310 Oakcrest Dr Apt 318, Columbia, SC 29223 | 2016-03-17 |
| 1134585243 | Robin Heaton | Occupational Therapy Assistant | 7601 Parklane Road, Columbia, SC 29223 | 2016-01-05 |
| Find all providers in zip 29223 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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|---|---|---|---|---|
| 1598200099 | Healthworks Med Group of South Carolina PC | Clinic/Center | 1200 Colonial Life Blvd W, Columbia, SC 29210-7670 | 2016-12-20 |
| 1902048333 | Hopefull Wishing Inc. | Clinic/Center | 132 Monteith St, Columbia, SC 29203-2714 | 2009-03-31 |
| 1801970793 | Curators of The University of Missouri | Clinic/Center | 1000 W Nifong Blvd Ste 2-200, Columbia, MO 65203-5661 | 2006-10-25 |
| 1174604201 | Prisma Health-midlands | Clinic/Center | 1333 Taylor St Ste 4e, Palmetto Health, Columbia, SC 29201-2923 | 2006-10-17 |
| 1053492280 | Prisma Health-midlands | Clinic/Center | 9 Medical Park Suite 305, Palmetto Health Richland Diabetes Education, Columbia, SC 29203-6863 | 2006-10-17 |
| 1104914464 | Way Station Inc | Clinic/Center | 9030 State Route 108, Columbia, MD 21045-1951 | 2006-10-11 |
| 1184675316 | South Carolina Dept of Mental Health Accounting Office | Clinic/Center | 8301 Farrow Rd, Columbia, SC 29203-3245 | 2006-05-12 |
| 1811594294 | Lexington Health Inc | Clinic/Center | 7035 Saint Andrews Rd, Columbia, SC 29212-1177 | 2020-10-08 |
| 1003455627 | Ethos Health Maryland 3 LLC | Clinic/Center | 10840 Little Patuxent Pkwy, Columbia, MD 21044-3115 | 2019-12-30 |
| 1912554353 | T&s Wellness LLC | Clinic/Center | 201 Columbia Mall Blvd Ste 189, Columbia, SC 29223-7550 | 2019-08-21 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.