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General NPI Number Information
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NPI Number | 1528465374
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Entity Type | Organization
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Legal Business Name | PRISMA HEALTH UNIVERSITY MEDICAL GROUP
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 7 INDEPENDENCE PT STE 300
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City | GREENVILLE
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State | SC
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Zip | 29615-4569
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Country | US
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Telephone | 864-522-3700
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Fax | 864-522-3705
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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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 | DIRECTOR
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Name | MS. KRISTI LAWRENCE
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Credential |
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Telephone | 864-522-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) 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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) 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 | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology 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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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