PROVIDENCE CARDIOLOGY LLC (NPI# 1083995641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083995641 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE CARDIOLOGY LLC |
| Other Organization Name | PROVIDENCE CARDIOLOGY |
| Practice Address |
3103 Sunset Blvd West Columbia SC 29169-4817 |
| Mailing Address |
2001 Laurel St Columbia SC 29204-1018 |
| Practice Telephone | 8037943950 |
| Practice Fax Number | 8037391485 |
| Mailing Telephone | 8032543278 |
| Mailing Fax Number | 8033768010 |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2012-06-08 |
| Authorized Official Name | KATHLEEN L KOENIG (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 8032543278 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP5822 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Cardiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790196293 | Providence Cardiology LLC | Internal Medicine | 114 Gateway Corporate Blvd, Suite 300, Columbia, SC 29203-9740 | 2014-05-19 |
| 1336497742 | Providence Cardiology LLC | Internal Medicine | 114 Gateway Corporate Blvd, Suite 330, Columbia, SC 29203-9740 | 2012-08-16 |
| 1265716039 | Providence Cardiology LLC | Internal Medicine | 2001 Laurel St, Columbia, SC 29204-1018 | 2011-09-28 |
| 1235410887 | Providence Cardiology LLC | Internal Medicine | 904 S 4th St Ste B, Hartsville, SC 29550-0704 | 2011-09-08 |
| 1003197666 | Providence Cardiology LLC | Internal Medicine | 124 Wren St, Barnwell, SC 29812-1527 | 2011-09-08 |
| 1376824920 | Providence Cardiology LLC | Internal Medicine | 506 North St, Bamberg, SC 29003-1319 | 2011-09-08 |
| 1760763312 | Providence Cardiology LLC | Internal Medicine | 1330 Haile St, Camden, SC 29020-3002 | 2011-09-08 |
| 1588945141 | Providence Cardiology LLC | Internal Medicine | 595 Newberry Hwy, Saluda, SC 29138-7808 | 2011-09-08 |
| Street Address |
3103 SUNSET BLVD |
| City | WEST COLUMBIA |
| State | SC |
| Zip Code | 29169-4817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457960726 | Jerry Scott Oreilly | Physical Therapy Assistant | 100 Dreher Rd, Suite 100, West Columbia, SC 29169 | 2020-07-23 |
| 1134759921 | A&m Medical, LLC | Durable Medical Equipment & Medical Supplies | 1053 Sunset Boulevard, West Columbia, SC 29169 | 2020-01-21 |
| 1750946067 | First Physical Therapy, LLC | Clinic/Center | 100 Dreher Rd., Suite 100, West Columbia, SC 29169 | 2019-05-02 |
| 1295217545 | Tynaka Kwans Wilson | Nurse Practitioner | Sc House Calls Inc, 1053 Center Street, West Columbia, SC 29169 | 2018-09-04 |
| 1588183826 | Kimberly Jane Jennings | Registered Nurse | 1052 Center Street, Sc House Calls Inc, West Columbia, SC 29169 | 2017-09-19 |
| 1164943213 | Jacob Luke Wayland | Emergency Medicine | Lexington Medical Center-emergency Medicine Dept, 2720 Sunset Blvd, West Columbia, SC 29169 | 2017-06-29 |
| 1740721232 | Heather Detwiler | Physical Therapy Assistant | 2705 Leaphart Rd., Carolina Gardens, West Columbia, SC 29169 | 2017-03-16 |
| 1588110761 | Virginia I Hall | Nurse Practitioner | 2720 Susnet Blvd, West Columbia, SC 29169 | 2016-08-29 |
| 1215395744 | Stacey Khalifa | Social Worker | 160 Medical Cir Fl 1, West Columbia, SC 29169 | 2016-01-28 |
| 1407252331 | Sandy Frye Boone | Counselor | 2318 Sunset Blvd # 2a, West Columbia, SC 29169 | 2014-11-04 |
| Find all providers in zip 29169 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124222807 | Columbia Cardiology, LLC | Internal Medicine | 131 Sunset Court, West Columbia, SC 29169-3405 | 2007-06-14 |
| 1831166602 | Lexington Heart Clinic, LLC | Internal Medicine | 120 Hospital Dr. W, West Columbia, SC 29169-3406 | 2006-03-01 |
| 1881667897 | Mitchell Wells Jacocks | Internal Medicine | 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 | 2006-02-09 |
| 1427057009 | Daniel P Bouknight | Internal Medicine | 3020 Sunset Blvd Ste 105, West Columbia, SC 29169-3494 | 2005-07-18 |
| 1417119017 | South Carolina Heart Center Pa | Internal Medicine | 2728 Sunset Blvd, Ste 401, West Columbia, SC 29169-4840 | 2008-06-26 |
| 1063696011 | Jonathan Kyle Hewett | Internal Medicine | 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 | 2007-12-27 |
| 1639208671 | William D. Brearley Jr. | Internal Medicine | 2728 Sunset Blvd Ste 300, West Columbia, SC 29169 | 2007-03-05 |
| 1275622979 | Stephen Earl Van Horn, Jr Jr. | Internal Medicine | 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 | 2006-10-12 |
| 1235247198 | Amy R. Epps | Internal Medicine | 2728 Sunset Blvd Ste 300, West Columbia, SC 29169-4815 | 2006-08-29 |
| 1427084102 | Ram G Penmetsa | Internal Medicine | 2728 Sunset Blvd, Suite 401, West Columbia, SC 29169-4840 | 2006-06-24 |
| Find all providers in WEST COLUMBIA | ||||
| City | WEST COLUMBIA |
| Zip Code | 29169 |
Please comment or provide details below to improve the information on PROVIDENCE CARDIOLOGY LLC.
| 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.