Provider Demographics
NPI:1942247382
Name:FAILE, ERIC JAMES IV (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:FAILE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:3909 S HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6138
Practice Address - Country:US
Practice Address - Phone:864-627-8878
Practice Address - Fax:864-627-9114
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC16084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC80104687OtherRR MEDICARE
SC160845Medicaid
SC571004971018OtherBCBS OF SC
SC5519125OtherAETNA
SC6991936OtherCIGNA
SC80104687OtherRR MEDICARE
SCF543387951Medicare PIN