Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
THORACIC & CARDIOVASCULAR ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
JESS JUDY (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
2750 LAUREL ST, STE 305, COLUMBIA, SC 29204-2038
(803) 254-5140
(803) 779-1279
Mailing address
114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Enumeration date
02/05/2016
Last updated
02/22/2017
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