PROVIDENCE HOSPITAL, LLC (NPI# 1003811290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003811290 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HOSPITAL, LLC |
| Other Organization Name | PROVIDENCE HEALTH |
| Practice Address |
2435 Forest Dr Columbia SC 29204-2026 |
| Mailing Address |
330 Seven Springs Way Brentwood TN 37027-4536 |
| Practice Telephone | 8032565300 |
| Practice Fax Number | 8032565935 |
| Mailing Telephone | 6159207000 |
| Mailing Fax Number | 6159208913 |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2017-04-27 |
| Authorized Official Name | VICTOR E. GIOVANETTI (PRESIDENT) |
| Authorized Official Telephone | 6159207000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282N00000X | General Acute Care Hospital | HTL821 | SC | Hospitals |
| N | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
ASF058 | SC | Ambulatory Health Care Facilities |
| Y | 282N00000X | General Acute Care Hospital | HTL820 | SC | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 429453 | 05 | |
| SC | 274472 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Health | Doing Business As Name - Organization |
| Street Address |
2435 FOREST DR |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184271223 | Taylor Trull | Physician Assistant | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-08-22 |
| 1336794262 | Jillian Janss | Physical Therapist | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-08-07 |
| 1962063115 | Meagan Kirkley Wall | Nurse Anesthetist, Certified Registered | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-06-27 |
| 1003376757 | Abigail Gottshall | Dietitian, Registered | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-03-20 |
| 1053875120 | Smita Patel | Specialist/Technologist, Other | 2435 Forest Dr, Columbia, SC 29204-2026 | 2019-01-23 |
| 1538662556 | Prunetta Brunson | Nurse Practitioner | 2435 Forest Dr, Columbia, SC 29204-2026 | 2018-03-15 |
| 1164925863 | Sheltana Michelle Hipps | Nurse Practitioner | 2435 Forest Dr, Columbia, SC 29204-2026 | 2018-03-09 |
| 1154841021 | Broad River Physicians Group, LLC | Emergency Medicine | 2435 Forest Dr, Columbia, SC 29204-2026 | 2017-06-22 |
| 1659818599 | Providence Professional Services LLC | Emergency Medicine | 2435 Forest Dr, Columbia, SC 29204-2026 | 2017-01-30 |
| 1427418318 | Providence Hospital LLC | Physical Therapist | 2435 Forest Dr, Columbia, SC 29204-2026 | 2016-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992215149 | Ricardo Colon II | Registered Nurse | 3000 Hampton Street, Columbia, SC 29204 | 2017-10-02 |
| 1780113522 | Carla Star Noe | Registered Nurse | Sc Department of Health and Environmental Control, 2100 Bull Street, Collumbia, SC 29204 | 2017-06-06 |
| 1124568514 | Kristy L Thompson | Nurse Practitioner | 1655 Bernardin Ave Ste 240, Columbia, SC 29204 | 2017-03-03 |
| 1982052031 | Harold Eugene Cook Iv | Podiatrist | 1730 St Julian Place, Columbia, SC 29204 | 2016-05-31 |
| 1851748974 | Shaquita Banks | Counselor | 1810 Allen Benedict Ct, A1, Columbia, SC 29204 | 2016-05-18 |
| 1265804835 | Premier Care, LLC | Case Management | 2712 Middleburg Drive, Suite 206, Columbia, SC 29204 | 2015-10-22 |
| 1023492287 | Shamiquia N. Mcpherson | Counselor | 1627 Auburn St., Columbia, SC 29204 | 2015-07-16 |
| 1285028449 | The Columbia Free Medical Clinic, Inc. | Clinic/Center | 1875 Harden Street, Columbia, SC 29204 | 2015-03-26 |
| 1629473459 | Leslie Wilson | Counselor | 2323 Lady Street, Columbia, SC 29204 | 2014-10-22 |
| 1053728683 | Candyce Sutton | Social Worker | 1135 Carter Street, Columbia, SC 29204 | 2014-07-15 |
| Find all providers in zip 29204 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710428321 | Palmetto Health Usc Medical Group | General Acute Care Hospital | Taylor Marion Sts, Columbia, SC 29220-0001 | 2017-03-15 |
| 1003351859 | Palmetto Health | General Acute Care Hospital | 808 Kawana Rd, Columbia, SC 29205-2033 | 2017-01-04 |
| 1285082040 | Jessica Teschner | General Acute Care Hospital | 3201 Ballard Mill Dr, Columbia, MO 65203-1875 | 2016-06-01 |
| 1932554466 | Palmetto Health Richland | General Acute Care Hospital | 5 Medical Park Rd., Columbia, SC 29203-6863 | 2016-05-03 |
| 1811237985 | Prisma Health-midlands | General Acute Care Hospital | 400 Palmettto Health Parkway, Columbia, SC 29212-1760 | 2013-02-26 |
| 1235402140 | Patience First LLC | General Acute Care Hospital | 9524 Twilight Ct, Columbia, MD 21046-1954 | 2012-02-23 |
| 1912293291 | Department of Neurology | General Acute Care Hospital | One Hospital Drive, Dc047.00, Columbia, MO 65212 | 2011-06-24 |
| 1720374044 | University Hospital & Clinics | General Acute Care Hospital | 1 Hospital Dr # Dc047.00, Columbia, MO 65201-5276 | 2011-06-24 |
| 1285920504 | University of Missouri - Columbia | General Acute Care Hospital | One Hospital Drive, Dc018.00, Columbia, MO 65212 | 2011-06-24 |
| 1851508089 | Palmetto Health | General Acute Care Hospital | 223 Stoneridge Drive, Suite B, Palmetto Healthy Start, Columbia, SC 29210 | 2007-05-17 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.