Provider Demographics
NPI:1265585541
Name:FLYNN, AMANDA BUSH (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BUSH
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE #2000
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-260-1590
Mailing Address - Fax:
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE #2000
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-260-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3313OtherRAILROAD MEDICARE
SC008743Medicaid
SCI45750Medicare UPIN
SCAA11667043Medicare PIN
SCAA11665965Medicare PIN
SCAA11661153Medicare PIN
SCDE3313OtherRAILROAD MEDICARE