Provider Demographics
NPI:1669785887
Name:UPSTATE BIRTH CENTER
Entity type:Organization
Organization Name:UPSTATE BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:J
Authorized Official - Middle Name:MEREINDA
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LM-CPM
Authorized Official - Phone:864-354-8166
Mailing Address - Street 1:409 MADISON CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1254
Mailing Address - Country:US
Mailing Address - Phone:864-354-8166
Mailing Address - Fax:
Practice Address - Street 1:1250 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-354-8166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty