NPIMap

Organization Active NPI

Sisters of Charity Providence Hospitals

  • Certified Registered Nurse Anesthetist
  • Columbia, SC
National Provider Identifier
1194796607
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SISTERS OF CHARITY PROVIDENCE HOSPITALS
Practice address
2435 Forest Drive
Columbia, SC 29204
Phone
(803) 454-2613
Fax
(803) 765-1732
NPI assigned
Feb 1, 2006
Organization subpart
Yes
Parent organization
SISTERS OF CHARITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jho R. Outlaw
Title
Executive Director
Phone
(803) 454-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

2435 Forest Drive
Columbia, SC 29204

Mailing address

PO Box 1467
Columbia, SC 29202
Phone (803) 454-2613

Other identifiers 1

IdentifierTypeStateIssuer
GP3278MedicaidSC

Other names 1

  • Providence Hospital CRNAs Doing business as

National Provider Directory

National Provider Directory
Part of
Sisters of Charity Providence Hospitals

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432684800000",
    "number": "1194796607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1467",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29202",
            "telephone_number": "803-454-2613",
            "fax_number": "803-765-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 FOREST DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29204",
            "telephone_number": "803-454-2613",
            "fax_number": "803-765-1732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISTERS OF CHARITY PROVIDENCE HOSPITALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISTERS OF CHARITY HOSPITAL",
        "enumeration_date": "2006-02-01",
        "last_updated": "2015-05-27",
        "status": "A",
        "authorized_official_last_name": "OUTLAW",
        "authorized_official_first_name": "JHO",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "803-454-2600"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3278",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Hospital CRNAs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.