Healthcare Provider Details

I. General information

NPI: 1265140057
Provider Name (Legal Business Name): FARBAC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 LAURENS RD
GREENVILLE SC
29607-5236
US

IV. Provider business mailing address

336 SCOTCH ROSE LN
GREER SC
29650-5267
US

V. Phone/Fax

Practice location:
  • Phone: 843-819-2926
  • Fax:
Mailing address:
  • Phone: 631-839-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARNEL BACKER
Title or Position: OWNER
Credential: MD
Phone: 843-819-2926