Providence Physician Practices LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

PROVIDENCE PHYSICIAN PRACTICES LLC

Doing business as

Providence Surgical Associates

Practice address

1655 Bernardin Ave
Ste 110
Columbia, SC 29204-2039

Phone

(803) 409-7130

NPI assigned

Mar 4, 2016

Organization subpart

No

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

Authorized official

Name

Jess Judy

Title

President

Phone

(615) 920-7000

Specialties & licenses 3

Addresses

Other names 1

• PROVIDENCE SURGICAL ASSOCIATES Doing business as

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1689034548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD",
            "address_2": "STE 425",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039740",
            "telephone_number": "803-865-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 BERNARDIN AVE",
            "address_2": "STE 110",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042039",
            "telephone_number": "803-409-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE SURGICAL ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Pathology Associates PA
• Providence Physician Practices LLC (Hospital Professional Services)
• Providence Physician Practices LLC (Anesthesia Associates of Providence)
• Providence Physician Practices LLC (Providence Orthopedics)
• Providence Physician Practices LLC
• Providence Physician Practices LLC (Thoracic & Cardiovascular Associates)
• Providence Physician Practices LLC (Carolina Cardiovascular Associates)
• Providence Physician Practices LLC (Midlands Pulmonary, Critical Care & Sleep Medicine)
• Providence Physician Practices LLC (Laurel Imaging Center)
• Providence Physician Practices, LLC (Laurel Imaging Center)

• Surgery Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; 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.