Providence Physician Practices, LLC
NPI #1255790499 in Columbia, South Carolina
Provider Information
- NPI Number
- 1255790499
- Entity Type
- Organization
- Organization Name
- Providence Physician Practices, LLC
- Primary Specialty
- Physiological Laboratory
- Enumeration Date
- Feb 16, 2016
- Last Updated
- Apr 25, 2022
Practice Location
- Address
- 2750 LAUREL ST
- Address 2
- SUITE 104
- City
- Columbia
- State
- South Carolina
- ZIP Code
- 29204-2038
- Phone
- (803) 799-9035
Authorized Official
- Name
- TERRENCE DILLON
- Title
- ASSISTANT SECRETARY
- Phone
- (502) 596-7220
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physiological Laboratory |
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