Provider Demographics
NPI:1619336344
Name:JOHN R ROWELL MD21640
Entity Type:Organization
Organization Name:JOHN R ROWELL MD21640
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:ROWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-242-5303
Mailing Address - Street 1:309 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4303
Mailing Address - Country:US
Mailing Address - Phone:864-242-5303
Mailing Address - Fax:
Practice Address - Street 1:309 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4303
Practice Address - Country:US
Practice Address - Phone:864-242-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7175261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center