NPIMap

Organization Active NPI

Providence Cardiology LLC

  • Cardiovascular Disease Physician
  • Columbia, SC
National Provider Identifier
1790196293
Registry record updated May 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PROVIDENCE CARDIOLOGY LLC
Practice address
114 Gateway Corporate Blvd
Suite 300
Columbia, SC 29203-9740
Phone
(803) 254-3278
Fax
(803) 376-8010
NPI assigned
May 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2014

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

Authorized official

Name
Larry R Ellis
Title
Ceo
Phone
(803) 254-3278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

114 Gateway Corporate Blvd
Suite 300
Columbia, SC 29203-9740

Mailing address

2001 Laurel St
Columbia, SC 29204-1018
Phone (803) 254-3278

Other names 1

  • Providence Cardiology Other name

National Provider Directory

National Provider Directory

Locations

108 Palmetto Park Blvd
Lexington, SC 29072
Phone (803) 254-3278

NPI Registry JSON

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

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400457600000",
    "number": "1790196293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 LAUREL ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292041018",
            "telephone_number": "803-254-3278",
            "fax_number": "803-376-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 GATEWAY CORPORATE BLVD",
            "address_2": "SUITE 300",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039740",
            "telephone_number": "803-254-3278",
            "fax_number": "803-376-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CARDIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-19",
        "last_updated": "2014-05-19",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-254-3278"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Cardiology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 19, 2014; 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.