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Organization
PROVIDENCE PHYSICIAN PRACTICES, LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES, LLC
Active
Other names
Providence Urology Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
SARA L MILLER (DIRECTOR)
(615) 920-7514
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD STE 440, COLUMBIA, SC 29203-9785
(803) 365-8620
(803) 365-8629
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
—
NULL
2085R0001X
Radiation Oncology Physician
—
—
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
11/28/2017
Last updated
12/17/2018
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