Provider Demographics
NPI:1346242757
Name:UPSTATE SPINE AND NEUROSURGERY CENTER
Entity Type:Organization
Organization Name:UPSTATE SPINE AND NEUROSURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-583-7265
Mailing Address - Street 1:1075 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2248
Mailing Address - Country:US
Mailing Address - Phone:864-583-7265
Mailing Address - Fax:864-591-0422
Practice Address - Street 1:1075 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2248
Practice Address - Country:US
Practice Address - Phone:864-583-7265
Practice Address - Fax:864-591-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207T00000X207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1863Medicaid
SCB92686Medicare UPIN
SCPA1863Medicaid
SCH09213Medicare UPIN
SC3680700001Medicare NSC
SCD99415Medicare UPIN
SC1547Medicare ID - Type Unspecified