Provider Demographics
NPI:1710944749
Name:UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN
Other - Org Name:DIVISION OF REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-455-1600
Mailing Address - Street 1:890 W FARIS RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4247
Mailing Address - Country:US
Mailing Address - Phone:864-455-1600
Mailing Address - Fax:864-455-3095
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 470
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4247
Practice Address - Country:US
Practice Address - Phone:864-455-1600
Practice Address - Fax:864-455-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19348261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC193481Medicaid
SC193481Medicaid