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NPI Code Detail

MEDICARE: GREENWOOD SURGICAL ASSOC.

MEDICARE: GREENWOOD SURGICAL ASSOC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0129XVascular Surgery Physician
2208600000XSurgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154437515
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREENWOOD SURGICAL ASSOC.
Provider Business Mailing Address
First Line : 160 ACADEMY AVE
Second Line :
City : GREENWOOD
State : SC
Zip : 29646-3808
Country : US
Telephone Number : 864-223-8090
Fax Number : 864-223-4026
Provider Business Practice Location Address
First Line : 160 ACADEMY AVE
Second Line :
City : GREENWOOD
State : SC
Zip : 29646-3808
Country : US
Telephone Number : 864-223-8090
Fax Number : 864-223-4026
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : HOPE A PRUITT
Credential :
Telephone Number : 864-223-8090
Provider Enumeration Date : 08/21/2006
Last Update Date : 04/03/2015

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1982648549 — SCOTT W GIBSON MD
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1609880715 — DR. KEVIN WRIGHT CARSON M.D.
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160 ACADEMY AVE
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1720194178 — ANGELIA GRAHAM BELL CRNFA
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1619083060 — JEFFREY E LANFORD MD
Practice Location Address:
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29646-3808
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Practice Fax: 864-223-4026

Directions to “GREENWOOD SURGICAL ASSOC. ” Practice Location

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