Healthcare Provider Details

I. General information

NPI: 1154438075
Provider Name (Legal Business Name): TRIBE513, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 VERDAE BLVD SUITE 200
GREENVILLE SC
29607-4021
US

IV. Provider business mailing address

525 VERDAE BLVD SUITE 200
GREENVILLE SC
29607-4021
US

V. Phone/Fax

Practice location:
  • Phone: 864-272-0388
  • Fax: 864-213-9237
Mailing address:
  • Phone: 864-272-0388
  • Fax: 864-213-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: MELISSA OOSTDYK
Title or Position: COORDINATOR, PROVIDER RELATIONS
Credential:
Phone: 864-272-0388