Provider Demographics
NPI:1861447682
Name:SPARTANBURG & PELHAM OB-GYN,P.A.
Entity Type:Organization
Organization Name:SPARTANBURG & PELHAM OB-GYN,P.A.
Other - Org Name:SPARTANBURG OB-GYN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-208-2345
Mailing Address - Street 1:250 N GROVE MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4222
Mailing Address - Country:US
Mailing Address - Phone:864-208-2345
Mailing Address - Fax:864-208-2366
Practice Address - Street 1:250 N GROVE MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4222
Practice Address - Country:US
Practice Address - Phone:864-208-2345
Practice Address - Fax:864-208-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1854Medicaid
SC1804Medicare PIN