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Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
ANESTHESIA ASSOCIATES OF PROVIDENCE
Organization subpart
No
Provider details
NPI number
Authorized official
JESS JUDY (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
2435 FOREST DR, COLUMBIA, SC 29204-2026
(803) 256-5300
Mailing address
114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
NULL
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
02/05/2016
Last updated
02/22/2017
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