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General NPI Number Information
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NPI Number | 1558754978
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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 | 03/10/2015
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 10630 CLEMSON BLVD SUITE 100
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City | SENECA
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State | SC
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Zip | 29678-4546
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Country | US
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Telephone | 864-482-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE PT STE 212
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City | GREENVILLE
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State | SC
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Zip | 29615-4536
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Country | US
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Telephone | 643-854-4790
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PROVIDER ENROLLMENT
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Name | KRISTI ANN LAWRENCE
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Credential |
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Telephone | 864-797-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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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 #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma 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 | 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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