Providence Cardiology LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

PROVIDENCE CARDIOLOGY LLC

Practice address

114 Gateway Corporate Blvd
Suite 330
Columbia, SC 29203-9740

Phone

(803) 254-3278

NPI assigned

Aug 16, 2012

Organization subpart

Yes

Parent organization

PROVIDENCE CARDIOLOGYAs reported in NPPES

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

Authorized official

Name

Larry Ellis

Title

Ceo

Phone

(803) 254-3278

Specialties & licenses 1

Addresses

Tax ID family

Providence Cardiology LLC2 organizations share this tax ID, including this one

Part of

Providence Cardiology LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Cardiology LLC

  • Cardiovascular Disease Physician
  • Columbia, SC
  • NPI 1265716039
  NPD tax ID

Practitioners 1

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

• Leon J Khoury Jr., MD

  • Cardiovascular Disease Physician
  • West Columbia, SC
  • NPI 1467498014
  NPD (past)

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345075200000",
    "number": "1336497742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 LAUREL ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292041018",
            "telephone_number": "803-254-3278",
            "fax_number": "803-376-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD",
            "address_2": "SUITE 330",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039740",
            "telephone_number": "803-254-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CARDIOLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE CARDIOLOGY",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-08-16",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-254-3278"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leverne M Prosser, MD
• Tracy Proveaux
• Aundrea Marie Provence
• Providence Cardiology
• Providence Cardiology LLC
• Providence Cardiology LLC
• Providence Cardiovascular & Thoracic Surgery, LLC
• Providence ER Services, LLC
• Providence Family Practice LLC
• Providence Group Practices II, LLC

• Cardiovascular Disease Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Cardiovascular Disease Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.