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Organization
PROVIDENCE PHYSICIAN PRACTICES, LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES, LLC
Active
Other names
Laurel Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE DILLON (ASSISTANT SECRETARY)
(502) 596-7220
Entity
Organization
Contact information
Practice address
2750 LAUREL ST, SUITE 104, COLUMBIA, SC 29204-2038
(803) 799-9035
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
02/16/2016
Last updated
04/25/2022
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