Healthcare Provider Details

I. General information

NPI: 1588892814
Provider Name (Legal Business Name): CASEY OLIVER HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FARIS RD STE B
GREENVILLE SC
29605-4296
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-6225
  • Fax: 864-522-6235
Mailing address:
  • Phone: 864-522-8603
  • Fax: 864-242-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101250468
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37101
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: