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Providence Group Practices II, LLC

Internal Medicine, Interventional Cardiology in Columbia, SC. Organization (NPI-2).

NPI number1396192001
StatusActive
Last updated in NPPESNov 23, 2020

Details

NPI
1396192001
Entity type
Organization (NPI-2)
Legal business name
Providence Group Practices II, LLC
Organization subpart
No
Enumeration date
May 23, 2016
Certification date
Nov 23, 2020
Last updated
Nov 23, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RI0011X Internal Medicine, Interventional Cardiology––Yes
207RC0000X Internal Medicine, Cardiovascular Disease––
207UN0901X Nuclear Medicine, Nuclear Cardiology––

Other names

  • Providence Heart (Doing Business As)

Practice location

1655 Bernardin Ave
Ste 220
Columbia, SC 29204-2039

Phone 803-409-7170 · Fax 803-409-7175

Mailing address

330 Seven Springs Way Ste 425
Brentwood, TN 37027-5098

Phone 615-920-7000

Authorized official

Kathy Teague
Avp, Corporate Secretary
6159207000

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