Provider Demographics
NPI:1255945754
Name:ESCOBEDO ADVANCED HEALTHCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:ESCOBEDO ADVANCED HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-319-5457
Mailing Address - Street 1:121 SPARKLEBERRY CROSSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8639
Mailing Address - Country:US
Mailing Address - Phone:803-788-2167
Mailing Address - Fax:803-788-4165
Practice Address - Street 1:121 SPARKLEBERRY CROSSING RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8639
Practice Address - Country:US
Practice Address - Phone:803-788-2167
Practice Address - Fax:803-788-4165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESCOBEDO ADVANCED HEALTHCARE SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty