MEDICARE: HEALTH CORE DIRECT

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1700353240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CORE DIRECT

Provider Business Mailing Address
First Line	:	101 N PINE ST STE 210
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1604
Country	:	US
Telephone Number	:	864-358-9278
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N PINE ST STE 210
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1604
Country	:	US
Telephone Number	:	864-358-9278
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACEY D MILLER
Credential	:	NP
Telephone Number	:	864-439-0959

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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Directions to “HEALTH CORE DIRECT ” Practice Location

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