DR. COLLEEN ANN WUNDERLICH (NPI# 1689702698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689702698 |
| Entity Type | Individual |
| Full Name | DR. COLLEEN ANN WUNDERLICH |
| Credential | M.D., MSC |
| Practice Address |
9 Richland Medical Park Dr Ste 410 Columbia SC 29203-6859 |
| Mailing Address |
Po Box 743904 Atlanta GA 30374-3904 |
| Practice Telephone | 8034347995 |
| Practice Fax Number | 8034348686 |
| Mailing Telephone | 8032967320 |
| Mailing Fax Number | 8032937330 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-07-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | 2007-00969 | NC | Allopathic & Osteopathic Physicians |
| N | 208100000X | Physical Medicine & Rehabilitation | 46317 | MN | Allopathic & Osteopathic Physicians |
| Y | 2081P0010X |
Physical Medicine & Rehabilitation Specialization: Pediatric Rehabilitation Medicine |
40616 | SC | Allopathic & Osteopathic Physicians |
| N | 2081P0010X |
Physical Medicine & Rehabilitation Specialization: Pediatric Rehabilitation Medicine |
2007-00969 | NC | Allopathic & Osteopathic Physicians |
| N | 2081P0010X |
Physical Medicine & Rehabilitation Specialization: Pediatric Rehabilitation Medicine |
0101238304 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NCBCBS | 1458X | 01 |
| SC | N69007 | 05 | |
| NC | 5907606 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 14 Richland Medical Park Dr Ste 400, Columbia, SC 292036878 | 8034347950 | 8034348606 |
| Street Address |
9 RICHLAND MEDICAL PARK DR STE 410 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29203-6859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285678078 | Prisma Health Medical Group-midlands | Pediatrics | 9 Richland Medical Park Dr Ste 410, Columbia, SC 29203-6859 | 2006-06-15 |
| 1104312867 | Angela Kokoska | Registered Nurse | 9 Richland Medical Park Dr Ste 410, Columbia, SC 29203-6859 | 2018-07-06 |
| 1083059232 | Jodi Dingle | Pediatrics | 9 Richland Medical Park Dr Ste 410, Columbia, SC 29203-6859 | 2013-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475284 | Matthew Leon Brigmon | Surgery | 2 Richland Medical Park, Suite 300, Columbia, SC 29203 | 2020-10-23 |
| 1730706839 | John James Gannon | Family Medicine | Prisma Health Medical Group Family Medicine, 3209 Colonial Drive, Columbia, SC 29203 | 2020-07-06 |
| 1790302362 | Klariz Teves Tucker | Internal Medicine | Internal Medcine Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-30 |
| 1811514482 | Esther Ruth Swan | Psychiatry & Neurology | Prisma Health General Psychiatry Center, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-30 |
| 1447877014 | Jordan Kaitlyn Merrels | Psychiatry & Neurology | Prisma Health Medical Group General Psychiatry, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-30 |
| 1306463187 | Jessica Leigh Watson | Psychiatry & Neurology | Prisma Health General Psychiatry, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-29 |
| 1053938852 | Garrison Glenn Rice | Family Medicine | Prisma Health Medical Group Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-29 |
| 1053938977 | Rachel Ellen Harper | Obstetrics & Gynecology | The Womens Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-26 |
| 1609493592 | Elizabeth Marie Kern | Orthopaedic Surgery | Prisma Health Medical Group Orthopedic Center, 2 Medical Park, Ste 105, Columbia, SC 29203 | 2020-06-26 |
| 1891312799 | Kathryn Victoria Steverson | Psychiatry & Neurology | Prisma Health Medical Group Psychiatry Center, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-26 |
| Find all providers in zip 29203 | ||||
| Taxonomy Code | 2081P0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pediatric Rehabilitation Medicine |
| A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood-onset physical impairments including related or secondary medical, physical, functional, psychosocial and vocational limitations or conditions, with an understanding of the life course of disability. This physician is trained in the identification of functional capabilities and selection of the best of rehabilitation intervention strategies, with an understanding of the continuum of care. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate for PRM was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Early discussions underway |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215412499 | Prisma Health-midlands | Physical Medicine & Rehabilitation | 7 Richland Medical Park Dr, Columbia, SC 29203-6863 | 2018-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033675061 | West Ashley Pediatric Therapy | Physical Medicine & Rehabilitation | 2738 Bolinas Ct, Charleston, SC 29414-6686 | 2019-02-14 |
| 1174614390 | Scott Evan Benjamin | Physical Medicine & Rehabilitation | 171 Ashley Ave, Charleston, SC 29425-8908 | 2006-09-27 |
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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.