Provider Demographics
NPI:1619022662
Name:S.F. WORSHAM MD PA
Entity Type:Organization
Organization Name:S.F. WORSHAM MD PA
Other - Org Name:S.F. WORSHAM MD PA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:WORSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-224-1316
Mailing Address - Street 1:109 BUFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-224-1316
Mailing Address - Fax:864-224-5068
Practice Address - Street 1:109 BUFORD AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-224-1316
Practice Address - Fax:864-224-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7940Medicare PIN