COLUMBIA MEDICAL GROUP (NPI# 1174506497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174506497 |
| Entity Type | Organization |
| Organization Name | COLUMBIA MEDICAL GROUP |
| Practice Address |
4540 Trenholm Rd Columbia SC 29206-4462 |
| Practice Telephone | 8037904700 |
| Practice Fax Number | 8037906130 |
| Mailing Telephone | 8037904700 |
| Mailing Fax Number | 8037906130 |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2007-10-16 |
| Authorized Official Name | MR. DAVID WILLIAM GAVIN (OFFICE MANAGER) |
| Authorized Official Telephone | 8037904700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 14628 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP2807 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306255237 | Columbia Medical Group | Nurse Practitioner | 3907 S Jog Rd, Greenacres, FL 33467-1590 | 2014-08-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | COLUMBIA MEDICAL GROUP - CLINCH VALLEY INC. | One Park Plaza, Nashville, Tennessee 37203 |
| Virginia Business Entities | COLUMBIA MEDICAL GROUP-SOUTHWEST VIRGINIA INC. | One Park Plaza, Nashville, Tennessee 37203 |
| Street Address |
4540 TRENHOLM RD |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29206-4462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669070785 | Lexington Health Inc | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2020-10-12 |
| 1619453602 | Lyndsey M Hughes | Nurse Practitioner | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2018-07-13 |
| 1497275895 | Mathew Papakyrikos Mazzola | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2017-06-27 |
| 1407195688 | Jennifer O Gillis | Nurse Practitioner | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2013-02-07 |
| 1659449544 | Erik Steven Crook | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2006-12-01 |
| 1326059627 | Huong T Phan | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2006-08-11 |
| 1891755039 | Ruben L Mayer | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2006-03-23 |
| 1225098478 | Stacie K Moore-bowens | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2006-03-23 |
| 1699734483 | Edgar G Deschamps IIi | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2006-03-21 |
| 1306805197 | Edward W Haselden Jr. | Internal Medicine | 4540 Trenholm Rd, Columbia, SC 29206-4462 | 2006-03-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710403720 | Twila Wilson | Adult Companion | 5741 D Imboden Street, Columbia, SC 29206 | 2017-08-21 |
| 1164978961 | Uri Reisman | Social Worker | 3730 Rockbridge Rd, Columbia, SC 29206 | 2016-08-31 |
| 1902237621 | Ronald Patrick Pellicer | Counselor | 6941 N Trenholm Rd Ste F102, Columbia, SC 29206 | 2013-12-05 |
| 1316376791 | Laraine Kim Jenkins | Counselor | 5211 Trenholm Rd, Suite B, Columbia, SC 29206 | 2013-11-05 |
| 1437409802 | Charles B Roman IIi | Pharmacist | 4711-5 Forest Drive, Columbia, SC 29206 | 2012-09-13 |
| 1306129879 | Rickey Gene Ayers | Counselor | 1800 Forest Drive, C, Columbia, SC 29206 | 2011-09-21 |
| 1285924316 | Lexington County Health Services District, Inc. | Internal Medicine | 4540 Trenholm Road, Columbia, SC 29206 | 2011-04-11 |
| 1144547860 | Alicia K. Harvey | Counselor | 5115 Forest Plaza Suite D, The Art and Play Therapy Center of S.c., Columbia, SC 29206 | 2010-04-21 |
| 1669703880 | Crystal Coleman | Occupational Therapist | 5234 Circle Dr, Columbia, SC 29206 | 2010-01-28 |
| 1689896938 | Carolina Dental Associates, P.a. | Dentist | 5101 Forest Drive, Columbia, SC 29206 | 2007-05-03 |
| Find all providers in zip 29206 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1740808815 | Thai Quoc Nguyen | Internal Medicine | University Hospital Ma421 Med Sciences Bldg, Columbia, MO 65212-0001 | 2020-07-06 |
| 1649898784 | Peter Egwom | Internal Medicine | University Hospital One Hospital Drive Dc.043.00, Columbia, MO 65212-0001 | 2020-07-06 |
| 1790302362 | Klariz Teves Tucker | Internal Medicine | Internal Medcine Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-30 |
| 1851918346 | Maxwell Isaac | Internal Medicine | University Hospital 1 Hospital Drive Dc 043.00, Columbia, MO 65212-0001 | 2020-06-30 |
| 1285251983 | Shannon Ejiofor | Internal Medicine | University Hospital One Hospital Drive Dc043.00, Columbia, MO 65212-0001 | 2020-06-29 |
| 1336766278 | Jordan Stauffer | Internal Medicine | University Hospital One Hospital Dr, Columbia, MO 65212-0001 | 2020-06-26 |
| 1972120814 | Pak Ho Au | Internal Medicine | University Hospital One Hospital Dr Dc043.00, Columbia, MO 65212-0001 | 2020-06-26 |
| 1700402849 | Michael Allan Goble | Internal Medicine | Internal Medical Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-24 |
| 1740806389 | Alan Verl Godfrey | Internal Medicine | University of Missouri Hospital 1 Hospital Dr, Columbia, MO 65212-0001 | 2020-06-19 |
| 1003432642 | Gregory Gaskey | Internal Medicine | University of Missouri Hospital One Hospital Drive, Columbia, MO 65212-0001 | 2020-06-19 |
| Find all providers in COLUMBIA | ||||
Please comment or provide details below to improve the information on COLUMBIA MEDICAL GROUP.
| 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.