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
1	251E00000X	Home Health Agency	HHA-0323	SC

General Provider Information

NPI Number	:	1538615653
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	:	864-455-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 ROPER MOUNTAIN RD
Second Line	:	SUITE C
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4242
Country	:	US
Telephone Number	:	864-522-5350
Fax Number	:

Authorized Official
Title or Position	:	VP PAYOR STRATEGIES & ALIGNMENT
Name	:	POLLY H. MILLER
Credential	:
Telephone Number	:	864-522-2286

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	02/02/2021

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Directions to “PRISMA HEALTH-UPSTATE ” Practice Location

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