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General NPI Number Information
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NPI Number | 1710944749
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Entity Type | Organization
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Legal Business Name | UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 890 W FARIS RD SUITE 470
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City | GREENVILLE
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State | SC
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Zip | 29605-4247
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Country | US
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Telephone | 864-455-1600
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Fax | 864-455-3095
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Provider Business Mailing Address
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Address Line | 890 W FARIS RD SUITE 470
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City | GREENVILLE
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State | SC
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Zip | 29605-4247
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Country | US
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Telephone | 864-455-1600
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Fax | 864-455-3095
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Authorized Official
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Title or Position | STAFF PHYSICIAN
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Name | DR. PAUL BRUCE MILLER
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Credential | MD
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Telephone | 864-455-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 19348
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License Number State | SC
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