PROVIDENCE PHYSICIAN PRACTICES LLC (NPI# 1689034548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689034548 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PHYSICIAN PRACTICES LLC |
| Other Organization Name | PROVIDENCE SURGICAL ASSOCIATES |
| Practice Address |
1655 Bernardin Ave Ste 110 Columbia SC 29204-2039 |
| Mailing Address |
114 Gateway Corporate Blvd Ste 425 Columbia SC 29203-9740 |
| Practice Telephone | 8034097130 |
| Mailing Telephone | 8038654780 |
| Enumeration Date | 2016-03-04 |
| 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 | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PROVIDENCE SURGICAL ASSOCIATES | 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 |
| 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 |
| 1033577002 | Providence Physician Practices LLC | Family Medicine | 2435 Forest Dr, Columbia, SC 29204-2026 | 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 |
1655 BERNARDIN AVE STE 110 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235138819 | Stephen Harmes Humphrey | Internal Medicine | 1655 Bernardin Ave, Suite 220, Columbia, SC 29204-2039 | 2005-07-18 |
| 1194264465 | Anna M Evans | Nurse Practitioner | 1655 Bernardin Ave, Pmob 3 Suite 220, Columbia, SC 29204-2039 | 2017-02-19 |
| 1760934673 | Falguni Patel | Physician Assistant | 1655 Bernardin Ave, Ste 240, Columbia, SC 29204-2039 | 2016-10-26 |
| 1396192001 | Providence Group Practices II, LLC | Internal Medicine | 1655 Bernardin Ave, Ste 220, Columbia, SC 29204-2039 | 2016-05-23 |
| 1790143766 | Providence Physician Practices LLC | Internal Medicine | 1655 Bernardin Ave, Ste 350, Columbia, SC 29204-2039 | 2016-02-05 |
| 1629457650 | Palmetto Pain Management, LLC | Non-Pharmacy Dispensing Site | 1655 Bernardin Ave, Suite 240, Columbia, SC 29204-2039 | 2015-05-22 |
| 1023410370 | Sabrina Marina Hilbert | Nurse Practitioner | 1655 Bernardin Ave, Suite 350, Columbia, SC 29204-2039 | 2014-09-18 |
| 1568899581 | Augustine Health Group | Surgery | 1655 Bernardin Ave, Suite 110, Columbia, SC 29204-2039 | 2013-10-04 |
| 1073833489 | Providence Pulmonary Specialists, LLC | Internal Medicine | 1655 Bernardin Ave, Suite 350, Columbia, SC 29204-2039 | 2010-06-08 |
| 1831414481 | Beau Taylor Bryan | Ophthalmology | 1655 Bernardin Ave, Suite 100, Columbia, SC 29204-2039 | 2010-04-06 |
| 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 | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| 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 Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801389788 | Michael Thomas Gibbons | Surgery | Surgery Clinic, 1801 Sunset Drive, Columbia, SC 29203 | 2018-06-14 |
| 1134623317 | Kuirong Jiang | Surgery | 1 Hospital Dr Rm Mc520, Columbia, MO 65212-1000 | 2018-03-21 |
| 1629576848 | Carolina Interventional Pain Institute, LLC | Surgery | 2611 Forest Dr Ste 100, Columbia, SC 29204-2371 | 2018-01-23 |
| 1578084349 | Shoaib Safiullah | Surgery | 1 Hospital Dr # Dc075.00, Columbia, MO 65212-1000 | 2017-07-03 |
| 1194117861 | Kaitlyn Marie Rountree | Surgery | 1 Hospital Dr # Mc404, Columbia, MO 65212-1000 | 2015-03-04 |
| 1215291604 | Rachel Alt | Surgery | One Hospital Drive, Dco75.00, Mc424, University of Missouri, Department of Surgery, Columbia, MO 65212 | 2012-06-29 |
| 1770847709 | Steven Junior Hermiz | Surgery | 1801 Sunset Blvd, Dept of Surg -, Columbia, SC 29203 | 2012-06-25 |
| 1003101684 | Patrick Davis | Surgery | 1222 Trotwood Ave Ste 603, Columbia, TN 38401 | 2011-06-13 |
| 1699086322 | Samantha Renee Cox | Surgery | 3 Richland Medical Park Dr Ste 330, Columbia, SC 29203 | 2010-06-28 |
| 1982837985 | Adair County Hospital District | Surgery | 902 Westlake Dr, Suite 107, Columbia, KY 42728-1149 | 2009-08-25 |
| 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.