Healthcare Provider Details

I. General information

NPI: 1275830507
Provider Name (Legal Business Name): SOUTHEAST PULMONARY AND CRITICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 S HERLONG AVE SUITE 200
ROCK HILL SC
29732-1160
US

IV. Provider business mailing address

370 HERLONG AVE S STE 200
ROCK HILL SC
29732-1160
US

V. Phone/Fax

Practice location:
  • Phone: 803-980-5864
  • Fax: 803-980-5817
Mailing address:
  • Phone: 803-980-5864
  • Fax: 803-980-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number21599
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number21599
License Number StateSC

VIII. Authorized Official

Name: CLAY W SPENCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-980-5864