Healthcare Provider Details

I. General information

NPI: 1750352332
Provider Name (Legal Business Name): SPARTANBURG REGIONAL HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEYWOOD AVE
SPARTANBURG SC
29302-1210
US

IV. Provider business mailing address

120 HEYWOOD AVE
SPARTANBURG SC
29302-1210
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-3860
  • Fax: 864-560-3712
Mailing address:
  • Phone: 864-560-3860
  • Fax: 864-560-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number22026
License Number StateSC

VIII. Authorized Official

Name: DR. EDWARD WARREN
Title or Position: PHYSICIAN
Credential: MD
Phone: 864-560-3860