MEDICARE: DR. SUSAN O. HILSMAN M.D.

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	207Q00000X	Family Medicine Physician	14054	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B920835019	OTHER	SC	MEDICARE PIN
5	B920838510	OTHER	SC	MEDICARE PIN
8	B920839068	OTHER	SC	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	20051874	OTHER	SC	SELECT HEALTH
3	189210	OTHER	SC	MEDCOST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7603088	OTHER	SC	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184604894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN O. HILSMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 743070
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3070
Country	:	US
Telephone Number	:	864-560-4304
Fax Number	:	864-560-4413

Provider Business Practice Location Address
First Line	:	853 N CHURCH ST
Second Line	:	SUITE 701
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-3098
Country	:	US
Telephone Number	:	864-560-1650
Fax Number	:	864-560-1655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	01/19/2021

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Directions to “ DR. SUSAN O. HILSMAN M.D.” Practice Location

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