1922035310 NPI number — ERIC HOLT TROUTMAN M.D.

Table of content: ERIC HOLT TROUTMAN M.D. (NPI 1922035310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922035310 NPI number — ERIC HOLT TROUTMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROUTMAN
Provider First Name:
ERIC
Provider Middle Name:
HOLT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922035310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E MCBEE AVE FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29601-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-522-8603
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MEMORIAL MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-4450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-295-4210
Provider Business Practice Location Address Fax Number:
864-295-0615
Provider Enumeration Date:
06/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  12470 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124704 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1539895 . This is a "CIGNA ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 160013851 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 571004971004 . This is a "BCBS OF SC ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 4259960 . This is a "AETNA ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".