PROVIDENCE PHYSICIAN PRACTICES, LLC (NPI# 1255790499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255790499 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN PRACTICES, LLC |
| Other Organization Name | LAUREL IMAGING CENTER |
| Practice Address |
2750 Laurel St Suite 104 Columbia SC 29204-2038 |
| Mailing Address |
330 Seven Springs Way Brentwood TN 37027-5098 |
| Practice Telephone | 8037999035 |
| Mailing Telephone | 6159207000 |
| Mailing Fax Number | 6159208913 |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2016-02-17 |
| Authorized Official Name | JESS N. JUDY (PRESIDENT) |
| Authorized Official Telephone | 6159207000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| Other Name | Type Code |
|---|---|
| Laurel Imaging Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659885754 | Providence Physician Practices, LLC | Radiology | 114 Gateway Corporate Blvd Ste 440, Columbia, SC 29203-9785 | 2017-11-28 |
| Street Address |
2750 LAUREL ST SUITE 104 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275536245 | Edgar Harold Peacock Jr. | Dentist | 2750 Laurel St, Ste 202, Columbia, SC 29204-2024 | 2005-05-24 |
| 1780124073 | Linda Lauren Mcmeekin Bradley | Nurse Practitioner | 2750 Laurel St, Suite 203, Columbia, SC 29204-2038 | 2017-03-06 |
| 1710345459 | Jeannie Morgan Woody | Audiologist | 2750 Laurel St, Suite 203, Columbia, SC 29204-2038 | 2016-02-09 |
| 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 |
| 1467875229 | Providence Health Network LLC | Physiological Laboratory | 2750 Laurel St, Suite 104, Columbia, SC 29204-2038 | 2014-01-30 |
| 1689944738 | Providence Health Network, LLC | Internal Medicine | 2750 Laurel St, Suite 303, Columbia, SC 29204-2038 | 2012-01-06 |
| 1295965051 | Palmetto Gastroenterology, Pa | Internal Medicine | 2750 Laurel St, Ste 201, Columbia, SC 29204-2038 | 2009-07-15 |
| 1689840514 | James Alan Henderson | Family Medicine | 2750 Laurel St, Suite 103, Columbia, SC 29204-2038 | 2008-04-30 |
| 1952587644 | Edgar H Peacock, Jr, Dds, Pa | Dentist | 2750 Laurel St, Suite 202, Columbia, SC 29204-2038 | 2008-01-14 |
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| 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 | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184099046 | Braincare, LLC | Physiological Laboratory | 1320 Main St Ste 347, Columbia, SC 29201-3204 | 2015-12-03 |
| 1184026098 | Braincare, LLC | Physiological Laboratory | 303 N Stadium Blvd, Ste 249, Columbia, MO 65203-1493 | 2014-09-23 |
| 1770638280 | Strategies Management Group | Physiological Laboratory | 1217 Hatcher Ln, Columbia, TN 38401 | 2007-01-24 |
| 1558304824 | Carolina Diagnostics, LLC | Physiological Laboratory | 1701 Devonshire Dr, Suite 102, Columbia, SC 29204-2404 | 2006-06-14 |
| 1902264971 | Providence Physician Practices LLC | Physiological Laboratory | 2750 Laurel St, Ste 104, Columbia, SC 29204-2038 | 2016-02-05 |
| 1467875229 | Providence Health Network LLC | Physiological Laboratory | 2750 Laurel St, Suite 104, Columbia, SC 29204-2038 | 2014-01-30 |
| 1467738468 | Arterial Health of Sc, LLC | Physiological Laboratory | 1201 Main St, Suite 1980, Columbia, SC 29201-3200 | 2011-10-24 |
| 1740517531 | Arterial Health, LLC | Physiological Laboratory | 1201 Main St, Suite 1980, Columbia, SC 29201-3200 | 2009-11-16 |
| 1588707897 | The Imaging Co Inc | Physiological Laboratory | 2712 Middleburg Dr, Suite 220, Columbia, SC 29204-2415 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609437961 | Tidelands Health Market Common LLC | Physiological Laboratory | 2200 Crow Ln Ste 103, Myrtle Beach, SC 29577-1663 | 2019-06-26 |
| 1780113324 | Carolinas Imaging Services LLC | Physiological Laboratory | 1656 Riverchase Blvd Ste 1600, Rock Hill, SC 29732-1984 | 2017-06-07 |
| 1114318813 | Palmetto Diagnostics, LLC | Physiological Laboratory | 1060 Chris Cir, Suite D, West Columbia, SC 29169-4773 | 2015-02-17 |
| 1568734614 | The Hark Group, LLC | Physiological Laboratory | 52 Golden Spur Ln, Blythewood, SC 29016-7600 | 2012-02-06 |
| 1255654877 | Atlantic Sleep Disorders Center LLC | Physiological Laboratory | 9657 S Ocean Hwy 17, Ste 4b, Pawleys Island, SC 29585-7425 | 2010-03-10 |
| 1619117678 | Charleston Neuroscience Institute LLC | Physiological Laboratory | 9551 Hwy 78, Bldg 700 Suite 103, Ladson, SC 29406 | 2009-03-03 |
| 1225278641 | Charleston Neuroscience Institute | Physiological Laboratory | 590 Lone Tree Drive Ste 101, Mount Pleasant, SC 29464 | 2009-02-25 |
| 1528017415 | Diagnostic Health Corporation | Physiological Laboratory | 1 Cannon Dr, Greenville, SC 29605-4201 | 2006-05-08 |
| 1174572069 | Diagnostic Health Center of Hilton Head LLC | Physiological Laboratory | 13 Lamotte Dr, Hilton Head Island, SC 29926-2743 | 2006-05-08 |
| 1700233541 | Salterbeck Sleep LLC | Physiological Laboratory | 3400 Salterbeck Ct, 100b, Mt Pleasant, SC 29466-7118 | 2016-05-23 |
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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.