MEDICARE: THOMAS W JARECKY MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	14792	SC
2	207L00000X	Anesthesiology Physician	14792	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SCA0535019	OTHER	SC	MEDICARE PIN
2	P00829559	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1619957354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS W JARECKY MD

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4545
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PATEWOOD DR
Second Line	:	SUITE C100
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3593
Country	:	US
Telephone Number	:	864-454-4643
Fax Number	:	864-454-4646

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/16/2021

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Directions to “ THOMAS W JARECKY MD” Practice Location

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