# NORTHLAKE FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336684851
- **Authorized official:** DR. ROBERT RAMOS MD (PRESIDENT / OWNER)
- **Authorized official phone:** (803) 622-3559

## Contact information

- **Practice address:** 115 BLARNEY DR, SUITE 101 C, COLUMBIA, SC 29223-6291
- **Practice address phone:** (803) 419-5131
- **Mailing address:** 115 BLARNEY DR, SUITE 101 C, COLUMBIA, SC 29223-6291
- **Mailing address phone:** (803) 419-5131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 19001 | SC | Yes |

## Other

- **Enumeration date:** 12/20/2016
- **Last updated:** 12/20/2016