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Organization
PROVIDENCE HOSPITAL, LLC
Active
Organization
PROVIDENCE HOSPITAL, LLC
Active
Other names
Providence Health
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY J. TEAGUE (ASSISTANT VICE PRESIDENT, SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
2435 FOREST DR, COLUMBIA, SC 29204-2026
(803) 256-5300
(803) 256-5935
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
ASF058
SC
282N00000X
General Acute Care Hospital
Primary
HTL820
SC
282N00000X
General Acute Care Hospital
HTL821
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274472
—
SC
05
—
429453
—
SC
Enumeration date
06/15/2005
Last updated
03/22/2021
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