Healthcare Provider Details

I. General information

NPI: 1598111353
Provider Name (Legal Business Name): SPARTANBURG MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 S HIGHWAY 14 SUITE 2200
GREER SC
29650-4902
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-849-9555
  • Fax: 864-849-9556
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateSC

VIII. Authorized Official

Name: KENNETH MEINKE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 864-560-6000