MEDICARE: CYBER GALENUS INC

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	261QM2500X	Medical Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1609204395	OTHER	SC	IND NPI

General Provider Information

NPI Number	:	1780262055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYBER GALENUS INC

Provider Business Mailing Address
First Line	:	3445 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4194
Country	:	US
Telephone Number	:	864-230-3823
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 PELHAM RD STE B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4194
Country	:	US
Telephone Number	:	864-230-3823
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANATER
Name	:	KELLY L BURCHIT
Credential	:	CBCS
Telephone Number	:	864-626-3374

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/30/2021

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Directions to “CYBER GALENUS INC ” Practice Location

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