Jack Gottlieb (NPI# 1720070840, PAC ID# 2062538382) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1720070840 |
| PAC ID by PECOS | 2062538382 |
| Professional Enrollment ID | I20100923001405 |
| Full Name | Jack Gottlieb |
| Organization Legal Name | PROVIDENCE PHYSICIAN PRACTICES, LLC |
| Address |
2601 Laurel St Suite 120 Columbia SC 29204-2034 |
| Phone Number | 8032547889 |
| Gender | M |
| Medical School | MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE |
| Graduation Year | 1966 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 9638475627 |
| Number of Group Practice Members | 30 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 420026 | PROVIDENCE HEALTH |
| 420018 | PALMETTO HEALTH RICHLAND |
| 420086 | PALMETTO HEALTH BAPTIST |
| 420073 | LEXINGTON MEDICAL CENTER |
| 420106 | PALMETTO HEALTH BAPTIST PARKRIDGE |
| Address | Phone | Organization |
|---|---|---|
| 2601 Laurel St, Suite 120, Columbia, SC 29204-2034 | 8032547889 | PROVIDENCE PHYSICIAN PRACTICES, LLC |
| Organization Legal Name | PROVIDENCE PHYSICIAN PRACTICES, LLC |
| Physicians | 39 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sherri L Mccain | Nurse Practitioner | Providence Physician Practices, LLC | 2351 Augusta Hwy, Lexington, SC 29072-2213 |
| Nusrat Ul Shafi | Family Medicine | Providence Physician Practices, LLC | 114 Gateway Corporate Blvd, Suite 350, Columbia, SC 29203-9785 |
| Robert P Zurcher | Cardiac Surgery | Providence Physician Practices, LLC | 2750 Laurel St, Suite 305, Columbia, SC 29204-2025 |
| Donna S Cambron | Nurse Practitioner | Providence Physician Practices, LLC | 2435 Forest Dr, Columbia, SC 29204-2026 |
| John P Sutton Iii | Cardiac Surgery | Providence Physician Practices, LLC | 2750 Laurel St, Suite 305, Columbia, SC 29204-2025 |
| Benedict R Studnicka | Internal Medicine | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Whitney P Pitts | Nurse Practitioner | Providence Physician Practices, LLC | 2750 Laurel St, Suite 303, Columbia, SC 29204-2025 |
| Charis P Taylor | Internal Medicine | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Kelly Cho Harris | General Surgery | Providence Physician Practices, LLC | 2750 Laurel St, Suite 200aandb, Columbia, SC 29204-2038 |
| Frederic A Smith | Internal Medicine | Providence Physician Practices, LLC | 2750 Laurel St, Suite 303, Columbia, SC 29204-2025 |
| Street Address |
2601 LAUREL ST SUITE 120 |
| City | COLUMBIA |
| State | SC |
| Zip | 29204-2034 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Stacy J Story | Ophthalmology | Eye Physicians and Surgeons of Columbia | 2601 Laurel St, Suite 110, Columbia, SC 29204-2034 |
| Cynthia M Volpe | Ophthalmology | Eye Physicians and Surgeons of Columbia | 2601 Laurel St, Suite 110, Columbia, SC 29204-2034 |
| Deborah L Fyffe | Ophthalmology | Eye Physicians and Surgeons of Columbia | 2601 Laurel St, Suite 110, Columbia, SC 29204-2034 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Erin Jaynes Belk | Nurse Practitioner | Providence Group Practices II LLC | 2001 Laurel St, Columbia, SC 29204-1018 |
| Benedict R Studnicka | Internal Medicine | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Charis P Taylor | Internal Medicine | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Brittany Winestock | Nurse Practitioner | Providence Group Practices II LLC | 2001 Laurel St, Columbia, SC 29204-1018 |
| Susan K Caudle | Physician Assistant | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Stephen Mullaney | Nurse Practitioner | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Ala Bianca Naomi Lucky | Nurse Practitioner | Providence Group Practices II LLC | 2001 Laurel St, Columbia, SC 29204-1018 |
| Kaitlin N Corwin | Physician Assistant | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Lanneau D Lide | Cardiovascular Disease (cardiology) | Providence Group Practices LLC | 2001 Laurel St, Columbia, SC 29204-1018 |
| Stephanie C Peterson | Physician Assistant | Providence Physician Practices, LLC | 2001 Laurel St, Suite 300, Columbia, SC 29204-1018 |
| Find all physicians in zip 29204 | |||
| City | COLUMBIA |
| Zip Code | 29204 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | COLUMBIA + INTERNAL MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.