Provider Demographics
NPI:1770586968
Name:SIMPSONVILLE FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:SIMPSONVILLE FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-8600
Mailing Address - Street 1:1336 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-527-8600
Mailing Address - Fax:864-527-8638
Practice Address - Street 1:1336 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-527-8600
Practice Address - Fax:864-527-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
SC16070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC160712Medicaid
SC1861430720OtherIND. NPI
SC182019Medicaid
SC1043244023OtherIND NPI
SC1184662033OtherIND NPI
SCE992Medicare PIN
SCP42269Medicare UPIN
SC160712Medicaid
SC1861430720OtherIND. NPI
SC1861430720OtherIND. NPI
SC6922Medicare ID - Type UnspecifiedGROUP ID
SCGP3023Medicaid
SCF96196Medicare UPIN
SC182019Medicaid
8157Medicare PIN
SC1184662033OtherIND NPI
SC1508890583OtherIND NPI
SC8157Medicare PIN