Provider Demographics
NPI:1780785675
Name:UPSTATE EMERGENCY PHYSICIANS LLC
Entity type:Organization
Organization Name:UPSTATE EMERGENCY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRANSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-297-6574
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-897-5013
Mailing Address - Fax:
Practice Address - Street 1:1700 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1041
Practice Address - Country:US
Practice Address - Phone:864-297-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98041199207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC155391700OtherDEPT OF LABOR GROUP #
SC020160500OtherGROUP FBLP #
SCCI5315OtherGROUP RR MEDICARE #
SCGP2430Medicaid
SC1536977OtherUMWA GROUP #
SC=========OtherBCBS/SC