NPIMap

Organization Active NPI

Augustine Health Group, LLC

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1750401451
Registry record updated Mar 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AUGUSTINE HEALTH GROUP, LLC
Practice address
300 Long Pointe LN
Suite 130
Columbia, SC 29229-7543
Phone
(803) 462-7193
Fax
(803) 462-7163
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2008

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

Authorized official

Name
Jeremy W Whitaker, CPC
Title
Manager
Phone
(803) 865-4798

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

300 Long Pointe LN
Suite 130
Columbia, SC 29229-7543

Mailing address

PO Box 60496
Charlotte, NC 28260-0496
Phone (803) 462-7193

Other identifiers 1

IdentifierTypeStateIssuer
GP4545MedicaidSC

Other names 1

  • Providence Northeast Family Care at Lake Carolina 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": "1204848000000",
    "number": "1750401451",
    "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": "803-462-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONG POINTE LN",
            "address_2": "SUITE 130",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292297543",
            "telephone_number": "803-462-7193",
            "fax_number": "803-462-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTINE HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2008-03-07",
        "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": "803-865-4798",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4545",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Northeast Family Care at Lake Carolina",
            "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 Mar 7, 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.