Healthcare Provider Details

I. General information

NPI: 1295988053
Provider Name (Legal Business Name): PRIMARY CARE ENDOSCOPY OF COLUMBIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 TAYLOR ST
COLUMBIA SC
29201-3452
US

IV. Provider business mailing address

3100 W END AVE SUITE 150
NASHVILLE TN
37203-1320
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-8449
  • Fax: 803-254-8984
Mailing address:
  • Phone: 615-345-6900
  • Fax: 615-345-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID WILLIAM HOLST
Title or Position: PRESIDENT, BOARD OF MANAGERS
Credential:
Phone: 615-345-6899