Healthcare Provider Details

I. General information

NPI: 1194796607
Provider Name (Legal Business Name): SISTERS OF CHARITY PROVIDENCE HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DRIVE
COLUMBIA SC
29204
US

IV. Provider business mailing address

PO BOX 1467
COLUMBIA SC
29202
US

V. Phone/Fax

Practice location:
  • Phone: 803-454-2613
  • Fax: 803-765-1732
Mailing address:
  • Phone: 803-454-2613
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JHO R. OUTLAW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-454-2600