Provider Demographics
NPI:1932305497
Name:COLUMBIA CENTRAL
Entity Type:Organization
Organization Name:COLUMBIA CENTRAL
Other - Org Name:CENTRAL COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-771-0518
Mailing Address - Street 1:3511 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6504
Mailing Address - Country:US
Mailing Address - Phone:803-771-0518
Mailing Address - Fax:803-771-7286
Practice Address - Street 1:3511 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6504
Practice Address - Country:US
Practice Address - Phone:803-771-0518
Practice Address - Fax:803-771-7286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC78092305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425294Medicaid
422529Medicare ID - Type Unspecified