Provider Demographics
NPI:1942960844
Name:PELHAM MEDICAL CENTER
Entity Type:Organization
Organization Name:PELHAM MEDICAL CENTER
Other - Org Name:PMC CENTER FOR UROLOGY PELHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-560-6103
Mailing Address - Street 1:PO BOX 198886
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8886
Mailing Address - Country:US
Mailing Address - Phone:864-604-1235
Mailing Address - Fax:864-560-4023
Practice Address - Street 1:250 WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-9013
Practice Address - Country:US
Practice Address - Phone:864-849-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-20
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9068OtherMEDICARE PIN
SCPG0796Medicaid