Healthcare Provider Details

I. General information

NPI: 1982654083
Provider Name (Legal Business Name): PROVIDENCE OCCUPATIONAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GATEWAY CORPORATE BLVD SUITE 430
COLUMBIA SC
29203-9740
US

IV. Provider business mailing address

114 GATEWAY CORPORATE BLVD SUITE 430
COLUMBIA SC
29203-9740
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-4920
  • Fax: 803-865-4925
Mailing address:
  • Phone: 803-865-4920
  • Fax: 803-865-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH ANN KARAM
Title or Position: PRESIDENT, CEO
Credential:
Phone: 803-256-5313