Organization
LAGNIAPPE MEDICAL CLINICS, LLC
Active
Parent organization
EVFI POLO ROAD LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVFI POLO ROAD LLC
Authorized official
MS. ANNETTE PLANTE (CEO)
(803) 419-7780
Entity
Organization
Contact information
Practice address
74 POLO RD, COLUMBIA, SC 29223-2806
(803) 419-7780
(803) 419-7781
Mailing address
74 POLO RD, COLUMBIA, SC 29223-2806
(803) 419-7780
(803) 419-7781
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20381
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7652
—
SC
01
—
PENDING
MEDICARE AND MEDICAID PENDING
SC
Enumeration date
09/01/2016
Last updated
09/18/2020
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