Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
Hospital Professional Services
Organization subpart
No
Provider details
NPI number
Authorized official
JESS JUDY (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
2435 FOREST DR, COLUMBIA, SC 29204-2026
(803) 256-5300
Mailing address
114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
133V00000X
Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
208800000X
Urology Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/05/2016
Last updated
02/22/2017
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