MEDICARE: UPSTATE LUNG AND CRITICAL CARE SPECIALISTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013963982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPSTATE LUNG AND CRITICAL CARE SPECIALISTS PC

Provider Business Mailing Address
First Line	:	151 HAROLD FLEMING CT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4225
Country	:	US
Telephone Number	:	864-573-6320
Fax Number	:	864-573-6323

Provider Business Practice Location Address
First Line	:	151 HAROLD FLEMING CT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4225
Country	:	US
Telephone Number	:	864-208-0347
Fax Number	:	864-573-6323

Authorized Official
Title or Position	:	CREDENTIAL COORDINATOR
Name	:	LASHANDA MAYBERRY
Credential	:
Telephone Number	:	864-573-6320

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/15/2023

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