Provider Demographics
NPI:1356926067
Name:SUPERIOR HEALTHCARE OF SPARTANBURG
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE OF SPARTANBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-404-0433
Mailing Address - Street 1:945 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2119
Mailing Address - Country:US
Mailing Address - Phone:864-586-1284
Mailing Address - Fax:
Practice Address - Street 1:945 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2119
Practice Address - Country:US
Practice Address - Phone:864-586-1284
Practice Address - Fax:864-586-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty