Provider Demographics
NPI:1649803313
Name:SYNERGY SPINE CENTER, PA
Entity type:Organization
Organization Name:SYNERGY SPINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCMILLAN, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-886-9888
Mailing Address - Street 1:457 U.S. HIGHWAY 123, SUITE D
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
Mailing Address - Country:US
Mailing Address - Phone:864-882-8850
Mailing Address - Fax:864-886-9777
Practice Address - Street 1:457 U.S. HIGHWAY 123, SUITE D
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:864-886-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ330370002OtherMEDICARE #
SCASC039Medicaid