Provider Demographics
NPI:1457399610
Name:RODY, RICHARD BRENT (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BRENT
Last Name:RODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:EMERGENCY CENTER
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-360-6000
Practice Address - Fax:864-560-7520
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27131207P00000X
SC29306207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20056298OtherSELECT HEALTH CHOICE
SC191231OtherMEDCOST
NC5905735Medicaid
SC293060Medicaid
SC5665765OtherAETNA
KS100298120FMedicaid
SCAA17139068Medicare PIN
SCAA17138510Medicare PIN
SC293060Medicaid
SCE27640Medicare UPIN
SCP00376563Medicare PIN