# AUGUSTINE HEALTH GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Anesthesia Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154749075
- **Authorized official:** KELLY MOWRER (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (216) 472-2741

## Contact information

- **Practice address:** 2435 FOREST DR, COLUMBIA, SC 29204-2026
- **Practice address phone:** (803) 865-4780
- **Practice address fax:** (803) 865-4932
- **Mailing address:** 7580 NORTHCLIFF AVE, SUITE 500, BROOKLYN, OH 44144-3270
- **Mailing address phone:** (855) 477-2477
- **Mailing address fax:** (216) 472-2740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2014
- **Last updated:** 03/29/2014