MEDICARE: FOOTHILLS NEPHROLOGY 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	207RN0300X	Nephrology 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

General Provider Information

NPI Number	:	1528025137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS NEPHROLOGY PC

Provider Business Mailing Address
First Line	:	126 DILLON DRIVE
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-1018
Country	:	US
Telephone Number	:	864-327-1212
Fax Number	:	864-327-1211

Provider Business Practice Location Address
First Line	:	126 DILLON DRIVE
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-1018
Country	:	US
Telephone Number	:	864-327-1212
Fax Number	:	864-327-1211

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LISA A ROLLINS
Credential	:	RN
Telephone Number	:	864-327-1212

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	10/04/2007

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