BULL ST. DISTRICT FAMILY PRACTICE LLC – NPI #1265232326
Family Medicine

The NUCC recommends this code not be used. Choose a more appropriate code.

BULL ST. DISTRICT FAMILY PRACTICE LLC is a provider located in COLUMBIA, SC. NPPES has assigned the NPI number 1265232326 to BULL ST. DISTRICT FAMILY PRACTICE LLC on March 18, 2025. It is a Type-2 NPI, indicating this NPI number is associated with an organization. This provider is also associated with 2 additional names listed below. The primary taxonomy selected by this provider is 207QA0505X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine, specializing in Adult Medicine

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for BULL ST. DISTRICT FAMILY PRACTICE LLC below.

NPI Profile for
BULL ST. DISTRICT FAMILY PRACTICE LLC

NPI Number
1265232326
Enumeration Date

(more than a year ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
BULL ST. DISTRICT FAMILY PRACTICE LLC
Other name(s)
All associated names:
Doing Business As (dba)
Bull St District Family Practice
Doing Business As (dba)
Cornell M. Clark, M.D.
Primary location
1417 GREGG ST
COLUMBIA, SC 29201-3527
Phone: (803) 915-0469 Fax:
Mailing address
PO BOX 99
COLUMBIA, SC 29202-0099
Phone: (803) 915-0469 Fax:
Organization Subpart
No
Authorized Official
CORNELL CLARK
MANAGING DIRECTOR
Phone: (702) 904-4077
Updated
Certification Date
Mar 18, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207QA0505X
- Family Medicine / Adult Medicine (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.