Provider Demographics
NPI:1013075712
Name:UPSTATE PLASTIC SURGERY
Entity Type:Organization
Organization Name:UPSTATE PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-968-0168
Mailing Address - Street 1:301 THE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-968-0168
Mailing Address - Fax:864-968-9248
Practice Address - Street 1:301 THE PARKWAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-968-0168
Practice Address - Fax:864-968-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467569574OtherNPI KEVIN M KELLER MD
1558475574OtherNPI ELIZABETH A ROTHMAN M
SC161372Medicaid
1952419863OtherNPI JAMES E LOVETT III MD
1467569574OtherNPI KEVIN M KELLER MD
SC161372Medicaid
G15524Medicare UPIN
1558475574OtherNPI ELIZABETH A ROTHMAN M
1952419863OtherNPI JAMES E LOVETT III MD
H76278Medicare UPIN