Provider Demographics
NPI:1285028449
Name:THE COLUMBIA FREE MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:THE COLUMBIA FREE MEDICAL CLINIC, INC.
Other - Org Name:THE FREE MEDICAL CLINIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:803-765-1503
Mailing Address - Street 1:1875 HARDEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1014
Mailing Address - Country:US
Mailing Address - Phone:803-765-1503
Mailing Address - Fax:803-779-6178
Practice Address - Street 1:1875 HARDEN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-765-1503
Practice Address - Fax:803-779-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherFREE CLINIC