Providence Physician Practices LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

PROVIDENCE PHYSICIAN PRACTICES LLC

Practice address

114 Gateway Corporate Blvd Ste 220a
Columbia, SC 29203-9785

Phone

(803) 365-8660

Fax

(803) 217-4178

NPI assigned

Apr 9, 2020

Organization subpart

No

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

Authorized official

Name

Kathy Teague

Title

Corporate Secretary

Phone

(615) 920-7646

Specialties & licenses 1

Addresses

Other names 1

• Providence Orthopedics Doing business as

Locations

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1285253336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD STE 220A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039785",
            "telephone_number": "803-365-8660",
            "fax_number": "803-217-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "615-920-7646"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Orthopedic Group, LLC
• Providence Orthopedic Group, LLC
• Providence Pathology Associates PA
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC

• Orthopaedic Surgery Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Orthopaedic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.