Provider Demographics
NPI:1356476584
Name:SPARTANBURG REGIONAL HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:SPARTANBURG REGIONAL HEALTHCARE DISTRICT
Other - Org Name:SPARTANBURG REGIONAL LIFELINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-560-3900
Mailing Address - Street 1:120 HEYWOOD AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1210
Mailing Address - Country:US
Mailing Address - Phone:864-560-3900
Mailing Address - Fax:864-560-3998
Practice Address - Street 1:120 HEYWOOD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1210
Practice Address - Country:US
Practice Address - Phone:864-560-3900
Practice Address - Fax:864-560-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME837Medicaid