Provider Demographics
NPI:1740232461
Name:KABAS, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:KABAS
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD STE 550
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4286
Practice Address - Country:US
Practice Address - Phone:864-455-6800
Practice Address - Fax:864-455-6825
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17132208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863101OtherBLUE CHOICE OF SC
SC5401174OtherAETNA
GA003168095AMedicaid
SC060066911OtherRR MEDICARE
SC171325Medicaid
SC576007863100OtherBCBS OF SC
SC9638703OtherCIGNA
SCF816003640Medicare PIN
SCF816007951Medicare PIN
SC576007863100OtherBCBS OF SC
SCSC05027111Medicare PIN