# PROVIDENCE PHYSICIAN PRACTICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MIDLANDS PULMONARY, CRITICAL CARE & SLEEP MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790143766
- **Authorized official:** JESS JUDY (PRESIDENT)
- **Authorized official phone:** (615) 920-7000

## Contact information

- **Practice address:** 1655 BERNARDIN AVE, STE 350, COLUMBIA, SC 29204-2039
- **Practice address phone:** (803) 253-7575
- **Practice address fax:** (803) 253-7571
- **Mailing address:** 114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
- **Mailing address phone:** (803) 865-4780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | Yes |
| 207RP1001X | Pulmonary Disease Physician | — | — | Yes |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 02/05/2016
- **Last updated:** 02/22/2017