# PROVIDENCE PHYSICIAN PRACTICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ANESTHESIA ASSOCIATES OF PROVIDENCE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083072045
- **Authorized official:** JESS JUDY (PRESIDENT)
- **Authorized official phone:** (615) 920-7000

## Contact information

- **Practice address:** 2435 FOREST DR, COLUMBIA, SC 29204-2026
- **Practice address phone:** (803) 256-5300
- **Mailing address:** 114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
- **Mailing address phone:** (803) 865-4780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 02/05/2016
- **Last updated:** 02/22/2017