Organization
74 POLO ROAD, LLC
Active
Parent organization
EVFI POLO ROAD LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVFI POLO ROAD LLC
Authorized official
JEFF LEHRICH (EXECUTIVE DIRECTOR)
(480) 235-7788
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
261QM1300X
Multi-Specialty Clinic/Center
Primary
20381
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE AND MEDICAID PENDING
SC
Enumeration date
09/01/2016
Last updated
09/01/2016
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