| Providence Family Practice LLC | |
|
2750 Laurel St Suite 103 Columbia SC 29204-2023 | |
| (803) 254-5171 | |
| (803) 779-7403 |
| Full Name | Providence Family Practice LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 2750 Laurel St, Columbia, South Carolina |
| Authorized Official Name and Position | Frampton W Henderson (MANAGING PARTNER) |
| Authorized Official Contact | 8032545171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Practice LLC 2750 Laurel St Suite 103 Columbia SC 29204-2038 Ph: (803) 254-5171 | Providence Family Practice LLC 2750 Laurel St Suite 103 Columbia SC 29204-2023 Ph: (803) 254-5171 |
| NPI Number | 1528066115 |
|---|---|
| Provider Enumeration Date | 07/08/2005 |
| Last Update Date | 06/23/2010 |
| Medicare PECOS PAC ID | 4284658865 |
|---|---|
| Medicare Enrollment ID | O20060123000299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528066115 | NPI | - | NPPES |
| GP2164 | Medicaid | SC | |
| CM5571 | Other | SC | RAILROAD MEDICARE |
| Provider Name | Frampton W Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407802184 PECOS PAC ID: 7810021565 Enrollment ID: I20100817000234 |
| Provider Name | Jaroslaw Mark Ambroziak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477506459 PECOS PAC ID: 6406971985 Enrollment ID: I20101012000331 |
| Provider Name | Theodore W Law |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447203583 PECOS PAC ID: 9032234513 Enrollment ID: I20101124000320 |
| Provider Name | James Alan Henderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689840514 PECOS PAC ID: 3375791809 Enrollment ID: I20120907000133 |
| Provider Name | Emily C Culler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1306575550 PECOS PAC ID: 3476938002 Enrollment ID: I20220919002273 |
| Provider Name | Amanda L Whitehead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194565515 PECOS PAC ID: 9537691654 Enrollment ID: I20241015000637 |
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