Provider Demographics
NPI:1023564622
Name:LAGNIAPPE MEDICAL CLINICS, LLC
Entity Type:Organization
Organization Name:LAGNIAPPE MEDICAL CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-419-7780
Mailing Address - Street 1:74 POLO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2806
Mailing Address - Country:US
Mailing Address - Phone:803-419-7780
Mailing Address - Fax:803-419-7781
Practice Address - Street 1:74 POLO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-2806
Practice Address - Country:US
Practice Address - Phone:803-419-7780
Practice Address - Fax:803-419-7781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVFI POLO ROAD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGOtherMEDICARE AND MEDICAID PENDING
SCGP7652Medicaid