Provider Demographics
NPI:1780823187
Name:UNION HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:UNION HOSPITAL DISTRICT
Other - Org Name:CHA UPSTATE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHA DIRECTOR PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-427-4081
Mailing Address - Street 1:720 S DUNCAN BYP
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-7830
Mailing Address - Country:US
Mailing Address - Phone:864-427-4081
Mailing Address - Fax:864-427-8733
Practice Address - Street 1:407 W. SOUTH ST. STE. C
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2771
Practice Address - Country:US
Practice Address - Phone:864-429-8846
Practice Address - Fax:864-429-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3026Medicaid