Provider Demographics
NPI:1740396480
Name:UPSTATE LUNG AND CRITICAL CARE SPECIALISTS, PC
Entity Type:Organization
Organization Name:UPSTATE LUNG AND CRITICAL CARE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-642-1924
Mailing Address - Street 1:151 HAROLD FLEMING CT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4225
Mailing Address - Country:US
Mailing Address - Phone:864-573-6320
Mailing Address - Fax:864-208-0352
Practice Address - Street 1:2755 S HIGHWAY 14 STE 2350
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4939
Practice Address - Country:US
Practice Address - Phone:864-642-1924
Practice Address - Fax:864-301-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RP1001X
SC207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3212Medicaid
SCGP3212Medicaid
SC7034Medicare UPIN