Broad River Physicians Group, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

BROAD RIVER PHYSICIANS GROUP, LLC

Practice address

120 Gateway Corporate Blvd
Columbia, SC 29203-9611

Phone

(803) 865-4500

NPI assigned

Jun 22, 2017

Last updated

Feb 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kim H Larsen

Title

Director of Credentialing

Phone

(770) 874-5400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1235659103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21801",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154115",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GATEWAY CORPORATE BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039611",
            "telephone_number": "803-865-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD RIVER PHYSICIANS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "770-874-5400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Alexander Britt
• Penny B Broach, APRN
• Ryan Broach
• Tasha Marie Broach, APRN
• Broad River Physicians Group, LLC
• Katelyn Broadus
• Aaliyah Broadwater
• Jeffrey Broadwell, CPO
• Gina Michelle Brock, FNP-C
• Mackenzie A Brock

• Emergency Medicine Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.