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General NPI Number Information
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NPI Number | 1770380909
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Entity Type | Organization
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Legal Business Name | UPSTATE THERATX LLC
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 230 BUIST AVE
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City | GREENVILLE
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State | SC
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Zip | 29609-4603
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Country | US
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Telephone | 864-215-5980
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Fax | 864-751-5108
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Provider Business Mailing Address
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Address Line | 206 BENNINGTON WAY
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City | GREER
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State | SC
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Zip | 29650-4010
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Country | US
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Telephone | 864-414-8888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMORY LOLLIS
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Credential |
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Telephone | 864-414-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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