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General NPI Number Information
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NPI Number | 1407301302
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Entity Type | Organization
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Legal Business Name | PRISMA HEALTH-UPSTATE
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 32 STONEY POINT DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4628
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Country | US
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Telephone | 864-522-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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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 | SVP FIN-ENTERPRISE PAYOR CONTRACTIN
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Name | POLLY MILLER
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Credential |
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Telephone | 864-522-2286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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