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General NPI Number Information
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NPI Number | 1003811290
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOSPITAL, LLC
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 2435 FOREST DR
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City | COLUMBIA
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State | SC
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Zip | 29204-2026
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Country | US
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Telephone | 803-256-5300
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Fax | 803-256-5935
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Provider Business Mailing Address
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Address Line | 330 SEVEN SPRINGS WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-5098
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Country | US
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Telephone | 615-920-7000
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Fax | 615-920-8913
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Authorized Official
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Title or Position | ASSISTANT VICE PRESIDENT, SECRETARY
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Name | KATHY J. TEAGUE
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Credential |
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Telephone | 615-920-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASF058
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | HTL821
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | HTL820
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License Number State | SC
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