Providence Group Practices II, LLC

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

PROVIDENCE GROUP PRACTICES II, LLC

Practice address

1655 Bernardin Ave
Ste 220
Columbia, SC 29204-2039

Phone

(803) 409-7170

Fax

(803) 409-7175

NPI assigned

May 23, 2016

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

Avp, Corporate Secretary

Phone

(615) 920-7000

Specialties & licenses 3

Addresses

Other names 1

• PROVIDENCE HEART Doing business as

Locations

Practitioners 1

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

• Amy Jeanette Dievendorf, APRN

  • Nurse Practitioner
  • Columbia, SC
  • NPI 1871802686
  NPD (past)

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1396192001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY STE 425",
            "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": "1655 BERNARDIN AVE",
            "address_2": "STE 220",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042039",
            "telephone_number": "803-409-7170",
            "fax_number": "803-409-7175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE GROUP PRACTICES II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "AVP,  CORPORATE SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HEART",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE HEART",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Cardiology LLC
• Providence Cardiology LLC
• Providence Cardiovascular & Thoracic Surgery, LLC
• Providence ER Services, LLC
• Providence Family Practice LLC
• Providence Group Practices LLC
• Providence Health Network LLC
• Providence Health Network, LLC
• Providence Hospital LLC
• Providence Hospital Northeast Transitional Care Unit

• Interventional Cardiology Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Interventional Cardiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.