Healthcare Provider Details

I. General information

NPI: 1437112299
Provider Name (Legal Business Name): STEVEN JACOB PIETRUSZA B.S.H.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ROCKCREEK BLVD
GREENWOOD SC
29649-8915
US

IV. Provider business mailing address

102 ROCKCREEK BLVD
GREENWOOD SC
29649-8915
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-5020
  • Fax: 864-725-5615
Mailing address:
  • Phone: 864-725-5020
  • Fax: 864-725-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3035
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: