Provider Demographics
NPI:1003875717
Name:HENSARLING, JEFFREY KIRK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KIRK
Last Name:HENSARLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10630 CLEMSON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4546
Practice Address - Country:US
Practice Address - Phone:864-482-6000
Practice Address - Fax:864-482-7166
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20679207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200045060OtherRR MEDICARE
SC206798Medicaid
SC431476513OtherBCBS
SCH435322348Medicare PIN
SC200045060OtherRR MEDICARE