Provider Demographics
NPI:1821051392
Name:AUGUSTINE HEALTH GROUP LLC
Entity Type:Organization
Organization Name:AUGUSTINE HEALTH GROUP LLC
Other - Org Name:PROVIDENCE WOMENS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR GENERAL ACCOUNTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:803-865-4583
Mailing Address - Street 1:114 GATEWAY CORP BLVD
Mailing Address - Street 2:SUITE 425
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9802
Mailing Address - Country:US
Mailing Address - Phone:803-865-4780
Mailing Address - Fax:803-865-4932
Practice Address - Street 1:114 GATEWAY CORP BLVD
Practice Address - Street 2:SUITE 350 AUGUSTINE HEALTH GROUP LLC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9802
Practice Address - Country:US
Practice Address - Phone:803-865-4780
Practice Address - Fax:803-865-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25087207Q00000X
SC21388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
SC7682Medicare PIN