1093781122 NPI number — SPARTANBURG NEUROLOGICAL CENTER, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093781122 NPI number — SPARTANBURG NEUROLOGICAL CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPARTANBURG NEUROLOGICAL CENTER, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1093781122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 SKYLYN DRIVE
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-542-2510
Provider Business Mailing Address Fax Number:
864-583-1311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 SKYLYN DRIVE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-542-2510
Provider Business Practice Location Address Fax Number:
864-583-1311
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EARLEY
Authorized Official First Name:
TREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
864-542-0088

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP0791 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com