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General NPI Number Information
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NPI Number | 1013996750
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Entity Type | Organization
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Legal Business Name | SYNERGY SPINE CENTER, PA
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 457D BY PASS 123
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City | SENECA
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State | SC
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Zip | 29678
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Country | US
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Telephone | 864-882-8850
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Fax | 864-882-0420
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Provider Business Mailing Address
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Address Line | 457D BY PASS 123
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City | SENECA
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State | SC
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Zip | 29678-0842
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Country | US
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Telephone | 864-882-8850
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Fax | 864-886-9777
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Authorized Official
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Title or Position | MEDICAL DIRECTOR OWNER
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Name | MARION R MCMILLAN III
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Credential | MD
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Telephone | 864-882-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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