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1225000573

NPI Code Detail

MEDICARE: KYLE ERNEST WATFORD MD

MEDICARE: KYLE ERNEST WATFORD MD

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	207X00000X	Orthopaedic Surgery Physician	20275	SC
2	207XX0801X	Orthopaedic Trauma Physician	20275	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	H640278552	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	055	OTHER	SC	BCBS
2	206186	OTHER	SC	MEDCOST
3	7574373	OTHER	SC	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8000830	OTHER	SC	CIGNA
7	20072627	OTHER	SC	SELECT HEALTH

General Provider Information

NPI Number	:	1225000573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ERNEST WATFORD MD

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE POINTE
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4536
Country	:	US
Telephone Number	:	864-797-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	10630 CLEMSON BLVD STE 100
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29678-4545
Country	:	US
Telephone Number	:	864-482-6000
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	08/31/2017

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Directions to “ KYLE ERNEST WATFORD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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