Healthcare Provider Details

I. General information

NPI: 1669785887
Provider Name (Legal Business Name): UPSTATE BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WADE HAMPTON BLVD SUITE C
GREENVILLE SC
29615
US

IV. Provider business mailing address

409 MADISON CREEK CT
LYMAN SC
29365-1254
US

V. Phone/Fax

Practice location:
  • Phone: 864-354-8166
  • Fax:
Mailing address:
  • Phone: 864-354-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number008
License Number StateSC

VIII. Authorized Official

Name: MS. J MEREINDA FISHER
Title or Position: OWNER
Credential: LM-CPM
Phone: 864-354-8166