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Organization

AUGUSTINE HEALTH GROUP LLC

Active
Parent organization
AUGUSTINE HEALTH GROUP LLC
Other names
Providence Physical Medicine and Rehabilitation
Organization subpart
Yes

Provider details

NPI number
Legal business name
AUGUSTINE HEALTH GROUP LLC
Authorized official
MRS. REGINA JOY FRAME (CREDENTIALING COORDINATOR)
(803) 865-4780
Entity
Organization

Contact information

Practice address
114 GATEWAY CORPORATE BLVD, SUITE 440, COLUMBIA, SC 29203
(803) 865-4780
(803) 865-4932
Mailing address
114 GATEWAY CORPORATE BLVD, SUITE 440, COLUMBIA, SC 29203
(803) 865-4780
(803) 865-4932

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP4785
SC
Enumeration date
03/10/2008
Last updated
03/10/2008
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