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NPI Code Detail

MEDICARE: PRISMA HEALTH-UPSTATE

MEDICARE: PRISMA HEALTH-UPSTATE
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1164102927
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRISMA HEALTH-UPSTATE
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 N NELSON DR
Second Line :
City : FOUNTAIN INN
State : SC
Zip : 29644-9021
Country : US
Telephone Number : 864-522-6270
Fax Number : 864-522-6275
Authorized Official
Title or Position : SVP FINANCE, ENTERPRISE CONTRACTING
Name : POLLY H MILLER
Credential :
Telephone Number : 864-522-2286
Provider Enumeration Date : 07/18/2023
Last Update Date : 10/12/2023

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Directions to “PRISMA HEALTH-UPSTATE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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