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Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
THREE RIVERS MEDICAL ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
JESS N JUDY (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
7936 BROAD RIVER RD, IRMO, SC 29063-2355
(803) 732-4001
(803) 732-2123
Mailing address
114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/13/2016
Last updated
02/23/2017
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