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General NPI Number Information
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NPI Number | 1154749075
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Entity Type | Organization
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Legal Business Name | AUGUSTINE HEALTH GROUP LLC
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 03/29/2014
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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 | 803-865-4780
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Fax | 803-865-4932
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Provider Business Mailing Address
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Address Line | 7580 NORTHCLIFF AVE SUITE 500
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City | BROOKLYN
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State | OH
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Zip | 44144-3270
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Country | US
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Telephone | 855-477-2477
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Fax | 216-472-2740
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KELLY MOWRER
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Credential |
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Telephone | 216-472-2741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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