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General NPI Number Information
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NPI Number | 1376422782
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Entity Type | Organization
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Legal Business Name | BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 406 N POINSETT HWY
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City | TRAVELERS REST
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State | SC
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Zip | 29690-1667
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Country | US
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Telephone | 864-234-7654
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Fax | 864-335-7458
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Provider Business Mailing Address
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Address Line | PO BOX 631341
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City | CINCINNATI
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State | OH
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Zip | 45263-1341
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PAYER DELEGATION
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Name | CASSIE LOWE
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Credential |
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Telephone | 513-952-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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