PROVIDENCE CARDIOVASCULAR & THORACIC SURGERY, LLC (NPI# 1811289382) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811289382 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE CARDIOVASCULAR & THORACIC SURGERY, LLC |
| Practice Address |
2435 Forest Dr Columbia SC 29204-2026 |
| Practice Telephone | 8032545140 |
| Practice Fax Number | 8037791279 |
| Mailing Telephone | 8032545140 |
| Mailing Fax Number | 8037791279 |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2011-05-04 |
| Authorized Official Name | JOHN P SUTTON, III (PRESIDENT) |
| Authorized Official Telephone | 8032545140 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | SISTERS OF CHARITY PROFVIDENCE HOSPITALS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Street Address |
2435 FOREST DR |
| 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 |
| 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 | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689135584 | Carmelita Voncille Mcdaniels | Specialist | 108 Columbia Northeast Dr, Columbia, SC 29223-6433 | 2019-03-26 |
| 1245768415 | Jacquelyn Clark | Specialist | 2000 N Beltline Blvd Apt 102e, Columbia, SC 29204-3976 | 2017-05-31 |
| 1659815470 | Colleen Jockin | Specialist | 100 Matc, Columbia, MO 65201 | 2016-12-13 |
| 1942659909 | Brainard Cooper | Specialist | 431 Williams, Columbia, SC 29208-4105 | 2016-06-09 |
| 1487028072 | Columbia Urgent Care, Inc | Specialist | 619 N. Providence Road, Columbia, MO 65203 | 2015-11-19 |
| 1790167690 | Wanda Al-lahabi | Specialist | 1030 St. Andrews Rd., Suite B-3, Columbia, SC 29210 | 2015-06-26 |
| 1235530296 | Touch and Agree Solutions | Specialist | 10724 Cordage Walk, Columbia, MD 21044-3641 | 2014-09-09 |
| 1033521711 | Charles Crawhorn | Specialist | 989 Portland Rd, Columbia, KY 42728-5283 | 2014-05-29 |
| 1235556028 | Allison Hammond | Specialist | 5500 Knoll North Dr Ste 150, Columbia, MD 21045-2476 | 2014-03-18 |
| 1588908024 | Frederick T Garner, Md, LLC | Specialist | 200 Arbor Lake Dr Ste 120, Columbia, SC 29223-4516 | 2012-11-21 |
| Find all providers in COLUMBIA | ||||
Please comment or provide details below to improve the information on PROVIDENCE CARDIOVASCULAR & THORACIC SURGERY, LLC.
| 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.