Healthcare Provider Details

I. General information

NPI: 1700176054
Provider Name (Legal Business Name): SPARTANBURG REGIONAL MED CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ROCKY SLOPE RD
GREENVILLE SC
29607-3909
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

Practice location:
  • Phone: 864-286-9229
  • Fax: 864-286-9228
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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