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Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
Providence Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (CORPORATE SECRETARY)
(615) 920-7646
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD STE 220A, COLUMBIA, SC 29203-9785
(803) 365-8660
(803) 217-4178
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
04/09/2020
Last updated
04/09/2020
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