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NPI Code Detail

MEDICARE: STEPHANIE GALE GROSS PA-C

MEDICARE: STEPHANIE GALE GROSS PA-C
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
1363A00000XPhysician Assistant50.005773RXOH
2363AS0400XSurgical Physician Assistant6130SC

General Provider Information

NPI Number : 1649730383
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GALE GROSS PA-C
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 : 864-695-6697
Fax Number :
Provider Business Practice Location Address
First Line : 10630 CLEMSON BLVD STE 100
Second Line :
City : SENECA
State : SC
Zip : 29678-4545
Country : US
Telephone Number : 864-482-6000
Fax Number : 864-482-7000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 01/12/2026

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Directions to “ STEPHANIE GALE GROSS PA-C” Practice Location

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