NPIMap

Organization Active NPI

Augustine Health Group, LLC

  • Forensic Psychiatry Physician
  • Columbia, SC
National Provider Identifier
1639375199
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Forensic Psychiatry PhysicianTaxonomy code 2084F0202X
License
19523 Issued in SC
Legal business name
AUGUSTINE HEALTH GROUP, LLC
Practice address
114 Gateway Corporate Blvd
Suite 425
Columbia, SC 29203-9740
Phone
(803) 256-5300
NPI assigned
Jun 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Authorized official

Name
Mr. Jeremy W. Whitaker
Title
Manager
Phone
(806) 865-4798

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084F0202X 19523 SC Primary

Addresses

Primary practice location

114 Gateway Corporate Blvd
Suite 425
Columbia, SC 29203-9740

Mailing address

PO Box 60496
Charlotte, NC 28260-0496
Phone (803) 256-5300

Other identifiers 1

IdentifierTypeStateIssuer
GP4739MedicaidSC

Other names 1

  • Providence Psychiatric Consults 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": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1639375199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60496",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600496",
            "telephone_number": "803-256-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD",
            "address_2": "SUITE 425",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039740",
            "telephone_number": "803-256-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTINE HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "806-865-4798",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "SC",
            "license": "19523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4739",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Psychiatric Consults",
            "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 Apr 29, 2008; 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.