Provider Demographics
NPI:1497893432
Name:JUNE P. SOUVIRON M.D.P.A.
Entity Type:Organization
Organization Name:JUNE P. SOUVIRON M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOUVIRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-231-7003
Mailing Address - Street 1:2405 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3276
Mailing Address - Country:US
Mailing Address - Phone:864-231-7003
Mailing Address - Fax:864-225-0233
Practice Address - Street 1:2405 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3276
Practice Address - Country:US
Practice Address - Phone:864-231-7003
Practice Address - Fax:864-225-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1698Medicaid
E969190282Medicare ID - Type Unspecified
SCGP1698Medicaid