MEDICARE: BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207XS0106X	Orthopaedic Hand Surgery Physician
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
3	207XS0117X	Orthopaedic Surgery of the Spine Physician
4	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
5	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
6	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1760361174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 631341
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-1341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 N MAIN ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1320
Country	:	US
Telephone Number	:	864-234-7654
Fax Number	:	864-675-1657

Authorized Official
Title or Position	:	DIRECTOR PAYER DELEGATION
Name	:	CASSIE LOWE
Credential	:
Telephone Number	:	513-952-5210

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	08/29/2025

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Directions to “BON SECOURS MEDICAL GROUP GREENVILLE SPECIALTY CARE LLC ” Practice Location

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