# PROVIDENCE PHYSICIAN PRACTICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Urology Specialists
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659885754
- **Authorized official:** SARA L MILLER (DIRECTOR)
- **Authorized official phone:** (615) 920-7514

## Contact information

- **Practice address:** 114 GATEWAY CORPORATE BLVD STE 440, COLUMBIA, SC 29203-9785
- **Practice address phone:** (803) 365-8620
- **Practice address fax:** (803) 365-8629
- **Mailing address:** 330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
- **Mailing address phone:** (615) 920-7000
- **Mailing address fax:** (615) 920-8775

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0001X | Radiation Oncology Physician | — | NULL | — |
| 2085R0001X | Radiation Oncology Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/28/2017
- **Last updated:** 12/17/2018