Healthcare Provider Details

I. General information

NPI: 1811027121
Provider Name (Legal Business Name): PIEDMONT COLON & RECTAL SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 DOCTORS PARK DR SUITE 210
SPARTANBURG SC
29307-1024
US

IV. Provider business mailing address

11 DOCTORS PARK DR SUITE 210
SPARTANBURG SC
29307-1024
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-1636
  • Fax: 864-580-5402
Mailing address:
  • Phone: 864-585-1636
  • Fax: 864-580-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number9944
License Number StateSC

VIII. Authorized Official

Name: GABOR F. SOVENYHAZY
Title or Position: PHYSICIAN
Credential: MD
Phone: 864-585-1636