PROVIDENCE HEALTH NETWORK, LLC (NPI# 1689944738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689944738 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH NETWORK, LLC |
| Other Organization Name | COLUMBIA MEDICAL ASSOCIATES |
| Practice Address |
2750 Laurel St Suite 303 Columbia SC 29204-2038 |
| Mailing Address |
114 Gateway Corporate Blvd Suite 425 Columbia SC 29203-9740 |
| Practice Telephone | 8032521953 |
| Practice Fax Number | 8032560138 |
| Mailing Telephone | 8038654780 |
| Mailing Fax Number | 8038654932 |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-01-06 |
| Authorized Official Name | MS. ANGELA HAITHCOCK (PROJECT MANAGER) |
| Authorized Official Telephone | 8038654780 |
| Is Organization Subpart | Y |
| Parent Organization Name | SISTERS OF CHARITY PROVIDENCE HOSPITALS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Columbia Medical Associates | Doing Business As Name - Organization |
| Street Address |
2750 LAUREL ST SUITE 303 |
| 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 |
| 1255790499 | Providence Physician Practices, LLC | Physiological Laboratory | 2750 Laurel St, Suite 104, Columbia, SC 29204-2038 | 2016-02-16 |
| 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 |
| 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 | 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 | ||||
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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.