MEDICARE: SPARTANBURG MEDICAL CENTER

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	207V00000X	Obstetrics & Gynecology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	6162	OTHER	SC	MEDICARE PIN

Other Identifiers

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

General Provider Information

NPI Number	:	1245815380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARTANBURG MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 743070
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3070
Country	:	US
Telephone Number	:	864-560-4304
Fax Number	:	864-560-4413

Provider Business Practice Location Address
First Line	:	3981 HIGHWAY 9 STE 201
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-8578
Country	:	US
Telephone Number	:	864-278-1400
Fax Number	:	864-278-1418

Authorized Official
Title or Position	:	CHEIF FINANCIAL OFFICER
Name	:	KENNETH J MEINKE
Credential	:
Telephone Number	:	864-560-6103

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	04/05/2021

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Directions to “SPARTANBURG MEDICAL CENTER ” Practice Location

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