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Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (AVP, SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
2001 LAUREL ST, STE 300, COLUMBIA, SC 29204-1018
(803) 254-2786
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
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Enumeration date
01/07/2016
Last updated
01/13/2021
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