Provider Demographics
NPI:1376223180
Name:PRISMA HEALTH-UPSTATE
Entity Type:Organization
Organization Name:PRISMA HEALTH-UPSTATE
Other - Org Name:PRISMA HEALTH PEDIATRICS-POWDERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE, ENTERPRISE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-2286
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:864-522-8613
Mailing Address - Fax:
Practice Address - Street 1:207 THREE BRIDGES RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7549
Practice Address - Country:US
Practice Address - Phone:864-220-1110
Practice Address - Fax:864-220-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty