Provider Demographics
NPI:1487854956
Name:UPSTATE NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:UPSTATE NEUROLOGY, P.A.
Other - Org Name:UPSTATE NEUROLOGY, P.A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-295-0051
Mailing Address - Street 1:PO BOX 8620
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8620
Mailing Address - Country:US
Mailing Address - Phone:864-295-0051
Mailing Address - Fax:
Practice Address - Street 1:103 CLAIR DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673
Practice Address - Country:US
Practice Address - Phone:864-295-0051
Practice Address - Fax:864-295-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDG2641OtherRAIL ROAD MEDICARE
SCGP3513Medicaid
SC6147440002Medicare NSC
SCGP3513Medicaid