Providence Physician Practices LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

PROVIDENCE PHYSICIAN PRACTICES LLC

Practice address

2750 Laurel St
Ste 104
Columbia, SC 29204-2038

Phone

(803) 799-9035

Fax

(803) 799-9710

NPI assigned

Feb 5, 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 2

Addresses

Other names 1

• LAUREL IMAGING CENTER Doing business as

Locations

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

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454630400000",
    "number": "1902264971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "STE 104",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-799-9035",
            "fax_number": "803-799-9710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "STE 104",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-799-9035",
            "fax_number": "803-799-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2016-02-05",
        "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": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAUREL IMAGING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices, LLC
• Providence Physician Practices, LLC
• Providence Professional Services LLC
• Providence Pulmonary Specialists, LLC
• Provident Place

• Diagnostic Radiology Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Diagnostic Radiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; 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.