Provider Demographics
NPI:1437108461
Name:NEPHROLOGY ASSOCIATES OF SPARTANBURG, LLC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF SPARTANBURG, LLC
Other - Org Name:SPARTANBURG NEPHROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-5099
Mailing Address - Street 1:322 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1631
Mailing Address - Country:US
Mailing Address - Phone:864-582-5099
Mailing Address - Fax:864-327-1098
Practice Address - Street 1:322 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1631
Practice Address - Country:US
Practice Address - Phone:864-582-5099
Practice Address - Fax:864-327-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907795Medicaid
SC8516OtherMEDICARE
SCDE7625OtherRAIL ROAD MEDICARE GRP#
SCGP4404Medicaid
SC20053685OtherSELECT HEALTH
SCGP4718Medicaid
NC5903663Medicaid