Organization
AUGUSTINE HEALTH GROUP, LLC
Active
Parent organization
SISTERS OF CHARITY PROVIDENCE HOSPITAL
Other names
Providence Internal Medicine Downtown
Organization subpart
Yes
Provider details
NPI number
Legal business name
SISTERS OF CHARITY PROVIDENCE HOSPITAL
Authorized official
MRS. ANGELA HAITHCOCK (CREDETIALING COORDINATOR)
(803) 865-4780
Entity
Organization
Contact information
Practice address
2601 LAUREL ST, SUITE 230, COLUMBIA, SC 29204-2033
(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
207R00000X
Internal Medicine Physician
Primary
1376
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA2264
RAILROAD MEDICARE GROUP NUMBER
SC
Enumeration date
06/07/2011
Last updated
06/07/2011
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