Healthcare Provider Details

I. General information

NPI: 1013075712
Provider Name (Legal Business Name): UPSTATE PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE PARKWAY
GREER SC
29650
US

IV. Provider business mailing address

301 THE PARKWAY
GREER SC
29650
US

V. Phone/Fax

Practice location:
  • Phone: 864-968-0168
  • Fax: 864-968-9248
Mailing address:
  • Phone: 864-968-0168
  • Fax: 864-968-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1467569574
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI KEVIN M KELLER MD
# 2
Identifier1558475574
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI ELIZABETH A ROTHMAN M
# 3
Identifier161372
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 4
Identifier1952419863
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI JAMES E LOVETT III MD

VIII. Authorized Official

Name: DR. KEVIN M KELLER
Title or Position: PHY OWNER
Credential: MD
Phone: 864-968-0168