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General NPI Number Information
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NPI Number | 1023392883
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Entity Type | Organization
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Legal Business Name | SPARTANBURG REGIONAL MED CTR
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 853 N CHURCH ST SUITE 401
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City | SPARTANBURG
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State | SC
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Zip | 29303-3098
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Country | US
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Telephone | 864-560-6287
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Fax | 864-560-7091
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Provider Business Mailing Address
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Address Line | PO BOX 2168
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City | SPARTANBURG
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State | SC
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Zip | 29304-2168
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Country | US
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Telephone | 864-560-4304
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Fax | 864-560-4413
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MARK AYCOCK
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Credential |
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Telephone | 864-560-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | SC
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