Provider Demographics
NPI:1104957471
Name:COLUMBIA ORTHOPAEDIC SPECIALISTS LLC
Entity type:Organization
Organization Name:COLUMBIA ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS REP
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-806-8198
Mailing Address - Street 1:1301 TAYLOR ST STE 3O
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2948
Mailing Address - Country:US
Mailing Address - Phone:803-806-8198
Mailing Address - Fax:803-806-8178
Practice Address - Street 1:1301 TAYLOR ST
Practice Address - Street 2:SUITE 3O
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2948
Practice Address - Country:US
Practice Address - Phone:803-806-8198
Practice Address - Fax:803-806-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8938332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies