NPIMap

Organization Active NPI

Augustine Health Group, LLC

Doing business as Jack H. Gottlieb, M.D.

  • Internal Medicine Physician
  • Columbia, SC
National Provider Identifier
1780998161
Registry record updated Feb 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5205 Issued in SC
Legal business name
AUGUSTINE HEALTH GROUP, LLC
Doing business as
Jack H. Gottlieb, M.D.
Practice address
2601 Laurel St
Suite 120
Columbia, SC 29204-2033
Phone
(803) 254-7889
Fax
(803) 254-7893
NPI assigned
Jul 28, 2010
Last updated
Feb 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 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 Physician 207R00000X 5205 SC Primary

Addresses

Primary practice location

2601 Laurel St
Suite 120
Columbia, SC 29204-2033

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
052052MedicaidSC

Other names 1

  • Jack H. Gottlieb, M.D. 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": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1780998161",
    "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": "2601 LAUREL ST",
            "address_2": "SUITE 120",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042033",
            "telephone_number": "803-254-7889",
            "fax_number": "803-254-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTINE HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2012-02-06",
        "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": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "5205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "052052",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jack H. Gottlieb, M.D.",
            "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 Feb 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.