NPIMap

Organization Active NPI

Augustine Health Group, LLC

Doing business as Providence Northeast Family Care

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1437279122
Registry record updated Feb 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AUGUSTINE HEALTH GROUP, LLC
Doing business as
Providence Northeast Family Care
Practice address
114 Gateway Corporate Blvd
Suite 230
Columbia, SC 29203-9740
Phone
(803) 788-2277
Fax
(803) 788-6508
NPI assigned
Mar 29, 2007
Last updated
Feb 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2012

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

Authorized official

Name
Angela Haithcock
Title
Project Manager
Phone
(803) 865-4780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

114 Gateway Corporate Blvd
Suite 230
Columbia, SC 29203-9740

Mailing address

PO Box 601964
Charlotte, NC 28260-1964
Phone (855) 477-2477

Other identifiers 1

IdentifierTypeStateIssuer
GP4383MedicaidSC

Other names 1

  • Providence Northeast Family Care Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1437279122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601964",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601964",
            "telephone_number": "855-477-2477",
            "fax_number": "216-472-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD",
            "address_2": "SUITE 230",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039740",
            "telephone_number": "803-788-2277",
            "fax_number": "803-788-6508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTINE HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "HAITHCOCK",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "PROJECT MANAGER",
        "authorized_official_telephone_number": "803-865-4780"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4383",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Northeast Family Care",
            "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 Feb 6, 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.