Healthcare Provider Details

I. General information

NPI: 1740735513
Provider Name (Legal Business Name): PRISMA HEALTH-UPSTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 QUEST DR
GREENVILLE SC
29605-3480
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 864-885-7188
  • Fax:
Mailing address:
  • Phone: 864-455-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number216
License Number StateSC

VIII. Authorized Official

Name: POLLY H. MILLER
Title or Position: SVP FINANCE, ENTERPRISE CONTRACTING
Credential:
Phone: 864-522-2286