Healthcare Provider Details

I. General information

NPI: 1578516001
Provider Name (Legal Business Name): SPARTANBURG REGIONAL MED CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 S HIGHWAY 14 SUITE 1200A-B
GREER SC
29650-4926
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

Practice location:
  • Phone: 864-879-1948
  • Fax: 864-849-9198
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN BRUCE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 864-560-4057