Organization
PROVIDENCE GROUP PRACTICES II, LLC
Active
Other names
PROVIDENCE HEART
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (AVP, CORPORATE SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1655 BERNARDIN AVE, STE 220, COLUMBIA, SC 29204-2039
(803) 409-7170
(803) 409-7175
Mailing address
330 SEVEN SPRINGS WAY STE 425, BRENTWOOD, TN 37027-5098
(615) 920-7000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
Primary
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Enumeration date
05/23/2016
Last updated
11/23/2020
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