MEDICARE: SPARTANBURG MEDICAL CENTER

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
2	207RR0500X	Rheumatology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5019	OTHER	SC	MEDICARE PIN
4	CN1627	OTHER	SC	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215912225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARTANBURG MEDICAL CENTER

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	:	1330 BOILING SPRINGS RD STE 1700
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4208
Country	:	US
Telephone Number	:	864-560-6844
Fax Number	:	864-560-7015

Authorized Official
Title or Position	:	CHIEF FINANICAL OFFICER
Name	:	KENNETH MEINKE
Credential	:
Telephone Number	:	864-560-6000

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	11/21/2018

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Directions to “SPARTANBURG MEDICAL CENTER ” Practice Location

Language	Start Address	Practice Location

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