Organization
AUGUSTINE HEALTH GROUP
Active
Other names
Providence Surgical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MOWRER (CREDENTIALING SPECIALIST)
(216) 472-2741
Entity
Organization
Contact information
Practice address
1655 BERNARDIN AVE, SUITE 110, COLUMBIA, SC 29204-2039
(803) 409-7130
(803) 252-8280
Mailing address
PO BOX 601964, CHARLOTTE, NC 28260-1964
(855) 477-2477
(216) 472-2740
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
10/04/2013
Last updated
10/07/2013
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