Provider Demographics
NPI:1780761684
Name:METROLYNA HEALTH CARE LLC
Entity type:Organization
Organization Name:METROLYNA HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IFEDIORA
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:AFULUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-273-4018
Mailing Address - Street 1:PO BOX 49089
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0073
Mailing Address - Country:US
Mailing Address - Phone:803-273-4018
Mailing Address - Fax:803-273-4023
Practice Address - Street 1:209 SOUTH COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:HEATH SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29058
Practice Address - Country:US
Practice Address - Phone:803-273-4018
Practice Address - Fax:803-273-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD20627261QM1300X
SC20627261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2762Medicaid
SCG82598Medicare UPIN
SCGP2762Medicaid