MEDICARE: UPSTATE SPINE AND NEUROSURGERY 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	207T00000X	Neurological Surgery Physician	207T00000X	SC

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

General Provider Information

NPI Number	:	1346242757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPSTATE SPINE AND NEUROSURGERY CENTER

Provider Business Mailing Address
First Line	:	1075 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2248
Country	:	US
Telephone Number	:	864-583-7265
Fax Number	:	864-591-0422

Provider Business Practice Location Address
First Line	:	1075 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2248
Country	:	US
Telephone Number	:	864-583-7265
Fax Number	:	864-591-0422

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILLIP ESCE
Credential	:	MD
Telephone Number	:	864-583-7265

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/19/2011

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