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NPI Code Detail

MEDICARE: PRISMA HEALTH UNIVERSITY MEDICAL GROUP

MEDICARE: PRISMA HEALTH UNIVERSITY MEDICAL GROUP
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
12085R0202XDiagnostic Radiology 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 : 1568799955
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRISMA HEALTH UNIVERSITY MEDICAL GROUP
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 : 864-522-8617
Fax Number :
Provider Business Practice Location Address
First Line : 1210 W FARIS RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-4444
Country : US
Telephone Number : 864-295-4410
Fax Number : 864-295-5694
Authorized Official
Title or Position : VP OF PAYOR STRATEGIES & ALIGNMENTS
Name : POLLY H MILLER
Credential :
Telephone Number : 864-522-2286
Provider Enumeration Date : 11/06/2009
Last Update Date : 05/12/2026

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Directions to “PRISMA HEALTH UNIVERSITY MEDICAL GROUP ” Practice Location

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