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Contact Information

PROVIDENCE HEALTH NETWORK LLC
2750 LAUREL ST
SUITE 104
COLUMBIA, SC29204-2038
 Phone: 803-799-9035
 Fax: 803-799-9710
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Physiological Laboratory, (Independent Physiological Lab)

293D00000X 47 Independent Diagnostic Testing Facility (IDTF)
Indicates primary specialty

NPI Profile & details for PROVIDENCE HEALTH NETWORK LLC · (Female)

NPI # 1467875229
Status Active
Credentials
Entity Individual
Enumeration date 01/30/2014
Last updated 06/23/2014 - About 12 years ago
Sole proprietor 1 Not specified
Identifiers
  • SC License # 40-5997
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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