Healthcare Provider Details

I. General information

NPI: 1013963982
Provider Name (Legal Business Name): UPSTATE LUNG AND CRITICAL CARE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 HAROLD FLEMING CT
SPARTANBURG SC
29303-4225
US

IV. Provider business mailing address

151 HAROLD FLEMING CT
SPARTANBURG SC
29303-4225
US

V. Phone/Fax

Practice location:
  • Phone: 864-208-0347
  • Fax: 864-573-6323
Mailing address:
  • Phone: 864-573-6320
  • Fax: 864-573-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LASHANDA MAYBERRY
Title or Position: CREDENTIAL COORDINATOR
Credential:
Phone: 864-573-6320