Healthcare Provider Details

I. General information

NPI: 1730376948
Provider Name (Legal Business Name): SPARTANBURG REGIONAL MED CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 SKYLYN DR SUITE 102
SPARTANBURG SC
29307-1058
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA HILLERS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 864-560-4057