Providence Health Network LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

40-5997 Issued in SC

Legal business name

PROVIDENCE HEALTH NETWORK LLC

Doing business as

Laurel Imaging Center

Practice address

2750 Laurel St
Suite 104
Columbia, SC 29204-2038

Phone

(803) 799-9035

Fax

(803) 799-9710

NPI assigned

Jan 30, 2014

Organization subpart

Yes

Parent organization

SISTERS OF CHARITY PROVIDENCE HOSPITALAs reported in NPPES

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

Authorized official

Name

George Zara

Title

Ceo

Phone

(803) 256-5300

Specialties & licenses 2

Addresses

Other names 1

• Laurel Imaging Center Doing business as

Part of

Sisters of Charity Providence Hospitals

Locations

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1467875229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 104",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29204",
            "telephone_number": "803-799-9035",
            "fax_number": "803-799-9710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 104",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-799-9035",
            "fax_number": "803-799-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISTERS OF CHARITY PROVIDENCE HOSPITAL",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "ZARA",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-256-5300"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "40-5997",
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "SC",
            "license": "40-5997",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providence Group Practices LLC
• Providence Health Network, LLC
• Providence Hospital LLC
• Providence Hospital Northeast Transitional Care Unit
• Providence Hospital, LLC
• Providence Occupational Health Services LLC

• Diagnostic Radiology Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Diagnostic Radiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.