Provider Demographics
NPI:1003626326
Name:PRISMA HEALTH-UPSTATE
Entity type:Organization
Organization Name:PRISMA HEALTH-UPSTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & CVO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-8611
Mailing Address - Street 1:PO BOX 402121
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2121
Mailing Address - Country:US
Mailing Address - Phone:864-454-9604
Mailing Address - Fax:
Practice Address - Street 1:727 SE MAIN ST STE 180
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3248
Practice Address - Country:US
Practice Address - Phone:864-455-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital