TODD L VANDENBERG (NPI# 1558367623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558367623 |
| Entity Type | Individual |
| Full Name | TODD L VANDENBERG |
| Credential | MD |
| Practice Address |
222 E Medical Ln Ste 101 West Columbia SC 29169-4850 |
| Mailing Address |
330 Seven Springs Way Brentwood TN 37027-5098 |
| Practice Telephone | 8037393660 |
| Practice Fax Number | 8037393663 |
| Mailing Telephone | 6159207878 |
| Mailing Fax Number | 6159208775 |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-10-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 20877 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | PHP | 1904812 | 01 |
| SC | 208778 | 05 | |
| SC | RAILROAD MEDICARE | 340017144 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 114 Gateway Corporate Blvd Ste 210, Columbia, SC 292039785 | 8033658620 | 8033658629 |
| 1747 Village Park Dr, Orangeburg, SC 291182475 | 8035345700 | 8035345712 |
| Street Address |
222 E MEDICAL LN STE 101 |
| City | WEST COLUMBIA |
| State | SC |
| Zip Code | 29169-4850 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568069888 | Lexington Health Inc | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4850 | 2020-10-09 |
| 1891334017 | Angela Page | Nurse Practitioner | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4850 | 2020-01-06 |
| 1164996369 | Colton W Bachman | Nurse Practitioner | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2019-01-22 |
| 1164907853 | Kristin Mckenzie Hartman | Nurse Practitioner | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2018-09-27 |
| 1184123630 | Jessica E Newell | Nurse Practitioner | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4850 | 2018-02-09 |
| 1437410594 | Melissa Kay Hodges | Physician Assistant | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4850 | 2012-06-06 |
| 1669572632 | Dawn Christina Pike | Nurse Practitioner | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2006-09-22 |
| 1609880780 | John C Rawl | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2006-07-27 |
| 1669486742 | Philip Whitaker Kinder | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2006-07-27 |
| 1962416073 | John G. Beasley Jr. | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2006-07-27 |
| Find all providers in the same location | ||||
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104049980 | Keith Eric Brightbill II | Urology | 111 W Hospital Dr, West Columbia, SC 29169-3405 | 2007-04-10 |
| 1164456422 | Michael J Stotzer | Urology | 139 Summerplace Drive, West Columbia, SC 29169 | 2006-07-10 |
| 1568069888 | Lexington Health Inc | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4850 | 2020-10-09 |
| 1356810626 | Lexington County Health Services District, Inc. | Urology | 222 East Medical Lane, Suite 101, West Columbia, SC 29169 | 2018-11-16 |
| 1831445212 | Carolina Urology Partners, Pllc | Urology | 139 Summerplace Dr, West Columbia, SC 29169-3058 | 2012-08-03 |
| 1407110315 | Griffin T. Morrisson | Urology | 111 W Hospital Dr, West Columbia, SC 29169-3405 | 2012-06-26 |
| 1912237074 | Midlands Urological Specialists | Urology | 139 Summerplace Dr, West Columbia, SC 29169-3058 | 2010-01-12 |
| 1013197631 | Truesdale & Morrow Urology | Urology | 2728 Sunset Blvd, Suite 301, West Columbia, SC 29169-4840 | 2007-11-12 |
| 1609880780 | John C Rawl | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2006-07-27 |
| 1669486742 | Philip Whitaker Kinder | Urology | 222 E Medical Ln Ste 101, West Columbia, SC 29169-4847 | 2006-07-27 |
| Find all providers in WEST COLUMBIA | ||||
| City | WEST COLUMBIA |
| Zip Code | 29169 |
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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.