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	261QP2000X	Physical Therapy Clinic/Center
2	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1578044053
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	:	864-522-8613
Fax Number	:

Provider Business Practice Location Address
First Line	:	11402 ANDERSON RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7560
Country	:	US
Telephone Number	:	864-335-4018
Fax Number	:	864-335-4019

Authorized Official
Title or Position	:	SVP FINANCE, ENTERPRISE CONTRACTING
Name	:	POLLY H. MILLER
Credential	:
Telephone Number	:	864-522-2286

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	04/11/2023

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Directions to “PRISMA HEALTH-UPSTATE ” Practice Location

Language	Start Address	Practice Location

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