Healthcare Provider Details

I. General information

NPI: 1649424151
Provider Name (Legal Business Name): SPARTANBURG MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 HIGHWAY 76 E OUTPATIENT CENTER, THIRD FLOOR
CLINTON SC
29325-7527
US

IV. Provider business mailing address

380 SERPENTINE DR SUITE 200
SPARTANBURG SC
29303-3066
US

V. Phone/Fax

Practice location:
  • Phone: 864-938-0620
  • Fax: 864-938-9830
Mailing address:
  • Phone: 864-560-7050
  • Fax: 864-560-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH MEINKE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 864-560-6000