MEDICARE: MRS. HEATHER RODEBAUGH STILL PA

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
1	207Q00000X	Family Medicine Physician	4275	SC

General Provider Information

NPI Number	:	1164175840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER RODEBAUGH STILL PA

Provider Business Mailing Address
First Line	:	461 CHRISTIANE WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5568
Country	:	US
Telephone Number	:	864-314-6196
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 N MAIN ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-3266
Country	:	US
Telephone Number	:	864-540-8430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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