Provider Demographics
NPI:1245331826
Name:COLUMBIA MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:COLUMBIA MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-252-1953
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0038
Mailing Address - Country:US
Mailing Address - Phone:803-252-1953
Mailing Address - Fax:803-256-0138
Practice Address - Street 1:2750 LAUREL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2038
Practice Address - Country:US
Practice Address - Phone:803-252-1953
Practice Address - Fax:803-256-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3957Medicare PIN