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General NPI Number Information
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NPI Number | 1578890273
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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 | 11/17/2009
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 200 PATEWOOD DR SUITE A200
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City | GREENVILLE
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State | SC
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Zip | 29615-3593
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Country | US
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Telephone | 864-454-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 7 INDEPENDENCE PT STE 140
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City | GREENVILLE
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State | SC
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Zip | 29615-4550
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Country | US
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Telephone | 864-385-4790
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PROVIDER ENROLLMENT & CVO
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Name | KRISTI ANN 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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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