Provider Demographics
NPI: | 1497900641 |
---|---|
Name: | SPARTANBURG REGIONAL MED CTR |
Entity Type: | Organization |
Organization Name: | SPARTANBURG REGIONAL MED CTR |
Other - Org Name: | SPARTANBURG REGIONAL PHYSICIAN NETWORK |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CONTRACT MANAGEMENT COORDINATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GINA |
Authorized Official - Middle Name: | MICHELLE |
Authorized Official - Last Name: | RUIZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 864-560-6457 |
Mailing Address - Street 1: | PO BOX 2168 |
Mailing Address - Street 2: | |
Mailing Address - City: | SPARTANBURG |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29304-2168 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-560-4304 |
Mailing Address - Fax: | 864-560-4413 |
Practice Address - Street 1: | 101 E WOOD ST |
Practice Address - Street 2: | |
Practice Address - City: | SPARTANBURG |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29303-3040 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-560-4304 |
Practice Address - Fax: | 864-560-4413 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2008-12-01 |
Last Update Date: | 2008-12-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086H0002X | Allopathic & Osteopathic Physicians | Surgery | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 2088P0231X | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | GP1118 | Medicaid |