Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Parent organization
SISTERS OF CHARITY PROVIDENCE HOSPITAL
Other names
Providence Family Medicine Cayce
Organization subpart
Yes
Provider details
NPI number
Legal business name
SISTERS OF CHARITY PROVIDENCE HOSPITAL
Authorized official
ANGELA HAITHCOCK (CREDENTIALING COORDINATOR)
(803) 865-4780
Entity
Organization
Contact information
Practice address
190 KNOX ABBOTT DR, SUITE 3-C, CAYCE, SC 29033-4348
(803) 865-4780
(803) 865-4932
Mailing address
114 GATEWAY CORPORATE BLVD, SUITE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
(803) 865-4932
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA2264
RAILROAD MEDICARE GROUP #
SC
Enumeration date
06/07/2011
Last updated
06/07/2011
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