Provider Demographics
NPI:1649220666
Name:EASTSIDE FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:EASTSIDE FAMILY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOD
Authorized Official - Middle Name:RAINSFORD
Authorized Official - Last Name:REEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-591-5900
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2244
Mailing Address - Country:US
Mailing Address - Phone:864-591-5900
Mailing Address - Fax:864-529-3358
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2244
Practice Address - Country:US
Practice Address - Phone:864-591-5900
Practice Address - Fax:864-529-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4281Medicaid
SCGP4281Medicaid