PROVIDENCE PATHOLOGY ASSOCIATES PA (NPI# 1780656363) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780656363 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PATHOLOGY ASSOCIATES PA |
| Practice Address |
2435 Forest Dr C/o Providence Hospital Columbia SC 29204-2026 |
| Mailing Address |
Po Box 30309 Charleston SC 29417-0309 |
| Practice Telephone | 8032565335 |
| Practice Fax Number | 8032565454 |
| Mailing Telephone | 8435549300 |
| Mailing Fax Number | 8435568780 |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2008-01-23 |
| Authorized Official Name | DR. JOSEPH ROBERT MODZELEWSKI (PRESIDENT) |
| Authorized Official Telephone | 8032565335 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
19654 | SC | Allopathic & Osteopathic Physicians |
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
19654 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP2746 | 05 |
| Street Address |
2435 FOREST DR C/O PROVIDENCE HOSPITAL |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003811290 | Providence Hospital, LLC | General Acute Care Hospital | 2435 Forest Dr, Columbia, SC 29204-2026 | 2005-06-15 |
| 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 |
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| 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 | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346732781 | Christopher Ryan Cunningham | Pathology | 1 Hospital Dr Dept Of, Columbia, MO 65212-1000 | 2018-06-01 |
| 1730679986 | Tao Zhang | Pathology | 1 Hospital Dr Bldg, Columbia, MO 65212-1000 | 2018-05-14 |
| 1871090258 | Hina Omer Khokhar | Pathology | 4601 Apt F West Millbrook Dr, Columbia, MO 65203 | 2018-04-11 |
| 1780061986 | Robert Jones | Pathology | 901 Rangeline St, Columbia, MO 65201-4562 | 2015-04-27 |
| 1407233604 | Jason Edward Denney | Pathology | 3601 W Broadway Apt 11-301, Columbia, MO 65203-0128 | 2015-04-27 |
| 1750647988 | Feriyl Bhaijee | Pathology | 10208 Hickory Ridge Rd, Apt. 104, Columbia, MD 21044-4686 | 2012-04-02 |
| 1932351764 | Kent J Newsom | Pathology | 1 Science Ct Ste 200, Professional Pathology Services, Columbia, SC 29203-9653 | 2008-10-10 |
| 1407967953 | John Logan Ward | Pathology | 30 Quinine Hl, Columbia, SC 29204-3414 | 2006-08-31 |
| 1790892594 | Joseph Elliott Benson Jr. | Pathology | 1107 Sequoya Trl, Columbia, TN 38401-8468 | 2006-08-25 |
| 1477585909 | Anita Godra | Pathology | 10320 Swift Stream Pl, #405, Columbia, MD 21044-4871 | 2006-07-07 |
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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.