PROVIDENCE PHYSICIAN PRACTICES LLC (NPI# 1033577002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033577002 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN PRACTICES LLC |
| Other Organization Name | HOSPITAL PROFESSIONAL SERVICES |
| Practice Address |
2435 Forest Dr Columbia SC 29204-2026 |
| Mailing Address |
114 Gateway Corporate Blvd Ste 425 Columbia SC 29203-9740 |
| Practice Telephone | 8032565300 |
| Mailing Telephone | 8038654780 |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2017-02-22 |
| Authorized Official Name | JESS JUDY (PRESIDENT) |
| Authorized Official Telephone | 6159207000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Hospital Professional Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285253336 | Providence Physician Practices LLC | Orthopaedic Surgery | 114 Gateway Corporate Blvd Ste 220a, Columbia, SC 29203-9785 | 2020-04-09 |
| 1659921740 | Providence Physician Practices LLC | Optometrist | 216 E Marion St, Kershaw, SC 29067-1442 | 2019-09-19 |
| 1558710376 | Providence Physician Practices LLC | Family Medicine | 7936 Broad River Rd, Irmo, SC 29063-2355 | 2016-06-13 |
| 1689034548 | Providence Physician Practices LLC | Plastic Surgery | 1655 Bernardin Ave, Ste 110, Columbia, SC 29204-2039 | 2016-03-04 |
| 1770943631 | Providence Physician Practices LLC | Internal Medicine | 114 Gateway Corporate Blvd, Ste 425, Columbia, SC 29203-9740 | 2016-03-04 |
| 1770941742 | Providence Physician Practices LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2750 Laurel St, Ste 305, Columbia, SC 29204-2038 | 2016-02-05 |
| 1902264971 | Providence Physician Practices LLC | Physiological Laboratory | 2750 Laurel St, Ste 104, Columbia, SC 29204-2038 | 2016-02-05 |
| 1083072045 | Providence Physician Practices LLC | Nurse Anesthetist, Certified Registered | 2435 Forest Dr, Columbia, SC 29204-2026 | 2016-02-05 |
| 1790143766 | Providence Physician Practices LLC | Internal Medicine | 1655 Bernardin Ave, Ste 350, Columbia, SC 29204-2039 | 2016-02-05 |
| 1689030595 | Providence Physician Practices LLC | Internal Medicine | 2001 Laurel St, Ste 300, Columbia, SC 29204-1018 | 2016-01-07 |
| Street Address |
2435 FOREST DR |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003811290 | Providence Hospital, LLC | General Acute Care Hospital | 2435 Forest Dr, Columbia, SC 29204-2026 | 2005-06-15 |
| 1184271223 | Taylor Trull | Physician Assistant | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-08-22 |
| 1336794262 | Jillian Janss | Physical Therapist | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-08-07 |
| 1962063115 | Meagan Kirkley Wall | Nurse Anesthetist, Certified Registered | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-06-27 |
| 1003376757 | Abigail Gottshall | Dietitian, Registered | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-03-20 |
| 1053875120 | Smita Patel | Specialist/Technologist, Other | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-01-23 |
| 1538662556 | Prunetta Brunson | Nurse Practitioner | 2435 Forest Dr, Columbia, SC 29204-2026 | 2018-03-15 |
| 1164925863 | Sheltana Michelle Hipps | Nurse Practitioner | 2435 Forest Dr, Columbia, SC 29204-2026 | 2018-03-09 |
| 1154841021 | Broad River Physicians Group, LLC | Emergency Medicine | 2435 Forest Dr, Columbia, SC 29204-2026 | 2017-06-22 |
| 1659818599 | Providence Professional Services LLC | Emergency Medicine | 2435 Forest Dr, Columbia, SC 29204-2026 | 2017-01-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992215149 | Ricardo Colon II | Registered Nurse | 3000 Hampton Street, Columbia, SC 29204 | 2017-10-02 |
| 1780113522 | Carla Star Noe | Registered Nurse | Sc Department of Health and Environmental Control, 2100 Bull Street, Collumbia, SC 29204 | 2017-06-06 |
| 1124568514 | Kristy L Thompson | Nurse Practitioner | 1655 Bernardin Ave Ste 240, Columbia, SC 29204 | 2017-03-03 |
| 1982052031 | Harold Eugene Cook Iv | Podiatrist | 1730 St Julian Place, Columbia, SC 29204 | 2016-05-31 |
| 1851748974 | Shaquita Banks | Counselor | 1810 Allen Benedict Ct, A1, Columbia, SC 29204 | 2016-05-18 |
| 1265804835 | Premier Care, LLC | Case Management | 2712 Middleburg Drive, Suite 206, Columbia, SC 29204 | 2015-10-22 |
| 1023492287 | Shamiquia N. Mcpherson | Counselor | 1627 Auburn St., Columbia, SC 29204 | 2015-07-16 |
| 1285028449 | The Columbia Free Medical Clinic, Inc. | Clinic/Center | 1875 Harden Street, Columbia, SC 29204 | 2015-03-26 |
| 1629473459 | Leslie Wilson | Counselor | 2323 Lady Street, Columbia, SC 29204 | 2014-10-22 |
| 1053728683 | Candyce Sutton | Social Worker | 1135 Carter Street, Columbia, SC 29204 | 2014-07-15 |
| Find all providers in zip 29204 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093200966 | Alexander John Lubinski | Radiology | 1 Hospital Drive Dco6910, Columbia, MO 65212 | 2018-06-24 |
| 1275028136 | Austin Fletcher | Radiology | University Hospital One Hospital Drive, Department of Radiology Dc 069.10, Columbia, MO 65212-0001 | 2018-06-24 |
| 1316467046 | Philip Silva | Radiology | 1 Hospital Drive University of Missouri, Columbia, MO 65212-0001 | 2017-06-23 |
| 1952832859 | Juhi Koolwal | Radiology | 1 Hospital Dirve Ddc06910, Columbia, MO 65212 | 2017-03-22 |
| 1467993386 | Iv Radiology Medical Group | Radiology | 10000 Town Center Ave, Apt 244, Columbia, MD 21044-5418 | 2017-03-10 |
| 1508216920 | David Koch | Radiology | 1 Hospital Drive, Dc06910, Columbia, MO 65212 | 2016-06-16 |
| 1023462439 | Robert Michael Robbins | Radiology | 1 Hospital Drive Columbia Mo 65212, Columbia, MO 65212-4973 | 2016-04-21 |
| 1669836292 | Brian Trissell | Radiology | 1 Hospital Drive Dc069.10, Columbia, MO 65212 | 2016-04-10 |
| 1295104073 | Arthur Knight Walter | Radiology | 737 River Rd, Columbia, SC 29212-8809 | 2015-09-22 |
| 1750765558 | Joel Schmidt | Radiology | 1 Hospital Drive, Dc069.10, Columbia, MO 65212 | 2015-07-13 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.