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General NPI Number Information
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NPI Number | 1013963982
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Entity Type | Organization
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Legal Business Name | UPSTATE LUNG AND CRITICAL CARE SPECIALISTS PC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 151 HAROLD FLEMING CT
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City | SPARTANBURG
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State | SC
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Zip | 29303-4225
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Country | US
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Telephone | 864-208-0347
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Fax | 864-573-6323
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Provider Business Mailing Address
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Address Line | 151 HAROLD FLEMING CT
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City | SPARTANBURG
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State | SC
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Zip | 29303-4225
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Country | US
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Telephone | 864-573-6320
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Fax | 864-573-6323
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Authorized Official
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Title or Position | CREDENTIAL COORDINATOR
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Name | LASHANDA MAYBERRY
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Credential |
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Telephone | 864-573-6320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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