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Contact Information

PROVIDENT HEALTH SERVICES, INC.
7 MALLET WAY
BLUFFTON, SC29910-6064
 Phone: 912-350-7412
 Fax: 912-350-7297
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
 

Surgical Oncology

2086X0206X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for PROVIDENT HEALTH SERVICES, INC.

NPI # 1366519530
LBN Legal business name PROVIDENT HEALTH SERVICES, INC.
Authorized official ROBIN MADDOX - (PROVIDER ENROLLMENT COORDINATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 11/30/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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