Provider Demographics
NPI:1013996750
Name:SYNERGY SPINE CENTER, PA
Entity Type:Organization
Organization Name:SYNERGY SPINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:864-882-8850
Mailing Address - Street 1:457D BY PASS 123
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0842
Mailing Address - Country:US
Mailing Address - Phone:864-882-8850
Mailing Address - Fax:864-886-9777
Practice Address - Street 1:457D BY PASS 123
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-8850
Practice Address - Fax:864-882-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC039Medicaid
SCASC039Medicaid
SCQ330370001Medicare UPIN