Organization
PROVIDENCE PHYSICIAN PRACTICES LLC
Active
Other names
LAUREL IMAGING CENTER
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 104, COLUMBIA, SC 29204-2038
(803) 799-9035
(803) 799-9710
Mailing address
2750 LAUREL ST, STE 104, COLUMBIA, SC 29204-2038
(803) 799-9035
(803) 799-9710
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
02/05/2016
Last updated
02/05/2016
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