# 74 POLO ROAD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EVFI POLO ROAD LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1093262628
- **Legal business name:** EVFI POLO ROAD LLC
- **Authorized official:** JEFF LEHRICH (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (480) 235-7788

## Contact information

- **Practice address:** 74 POLO RD, COLUMBIA, SC 29223-2806
- **Practice address phone:** (803) 419-7780
- **Practice address fax:** (803) 419-7781
- **Mailing address:** 74 POLO RD, COLUMBIA, SC 29223-2806
- **Mailing address phone:** (803) 419-7780
- **Mailing address fax:** (803) 419-7781

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 20381 | SC | Yes |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 09/01/2016