| Providence Internal Medicine | |
|
1655 Bernardin Ave Suite 110 Columbia SC 29204-2039 | |
| (803) 254-4056 | |
| (803) 254-4120 |
| Full Name | Providence Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1655 Bernardin Ave, Columbia, South Carolina |
| Authorized Official Name and Position | Jeremy W. Whitaker (MANAGER) |
| Authorized Official Contact | 8038654798 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Internal Medicine Po Box 60496 Charlotte NC 28260-0496 Ph: (803) 254-4056 | Providence Internal Medicine 1655 Bernardin Ave Suite 110 Columbia SC 29204-2039 Ph: (803) 254-4056 |
| NPI Number | 1518087287 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 03/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518087287 | NPI | - | NPPES |
| GP4662 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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