Healthcare Provider Details

I. General information

NPI: 1922243674
Provider Name (Legal Business Name): SPARTANBURG REGIONAL MED CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 HALTON RD
GREENVILLE SC
29607-3405
US

IV. Provider business mailing address

PO BOX 26536
GREENVILLE SC
29616-1536
US

V. Phone/Fax

Practice location:
  • Phone: 864-331-3230
  • Fax: 864-331-3236
Mailing address:
  • Phone: 864-331-3230
  • Fax: 864-331-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK AYCOCK
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 864-560-6000