Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
MIDLANDS PULMONARY, CRITICAL CARE & SLEEP MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
JESS JUDY (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1655 BERNARDIN AVE, STE 350, COLUMBIA, SC 29204-2039
(803) 253-7575
(803) 253-7571
Mailing address
114 GATEWAY CORPORATE BLVD, STE 425, COLUMBIA, SC 29203-9740
(803) 865-4780
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
02/05/2016
Last updated
02/22/2017
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