NPIMap

Organization Active NPI

Providence Health Network, LLC

  • Internal Medicine Physician
  • Columbia, SC
National Provider Identifier
1689944738
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROVIDENCE HEALTH NETWORK, LLC
Practice address
2750 Laurel St
Suite 303
Columbia, SC 29204-2038
Phone
(803) 252-1953
Fax
(803) 256-0138
NPI assigned
Jan 6, 2012
Organization subpart
Yes
Parent organization
SISTERS OF CHARITY PROVIDENCE HOSPITALSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2750 Laurel St
Suite 303
Columbia, SC 29204-2038

Mailing address

114 Gateway Corporate Blvd
Suite 425
Columbia, SC 29203-9740
Phone (803) 865-4780

Other names 1

  • Columbia Medical Associates Doing business as

National Provider Directory

National Provider Directory
Part of
Sisters of Charity Providence Hospitals

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1689944738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD",
            "address_2": "SUITE 425",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039740",
            "telephone_number": "803-865-4780",
            "fax_number": "803-865-4932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 303",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-252-1953",
            "fax_number": "803-256-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH NETWORK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISTERS OF CHARITY PROVIDENCE HOSPITALS",
        "enumeration_date": "2012-01-06",
        "last_updated": "2012-01-06",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Medical Associates",
            "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 Jan 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.