| Providence Internal Medicine Northeast | |
|
114 Gateway Corporate Blvd Suite 330 Columbia SC 29203-9740 | |
| (803) 865-4514 | |
| (803) 865-4932 |
| Full Name | Providence Internal Medicine Northeast |
|---|---|
| Speciality | Internal Medicine |
| Location | 114 Gateway Corporate Blvd, Columbia, South Carolina |
| Authorized Official Name and Position | Angela Haithcock (PROJECT MANAGER) |
| Authorized Official Contact | 8038654780 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Internal Medicine Northeast 114 Gateway Corporate Blvd Suite 425 Columbia SC 29203-9740 Ph: (803) 865-4780 | Providence Internal Medicine Northeast 114 Gateway Corporate Blvd Suite 330 Columbia SC 29203-9740 Ph: (803) 865-4514 |
| NPI Number | 1144523051 |
|---|---|
| Provider Enumeration Date | 12/15/2010 |
| Last Update Date | 02/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144523051 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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