1437108461 NPI number — NEPHROLOGY ASSOCIATES OF SPARTANBURG, LLC

Table of content: (NPI 1437108461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437108461 NPI number — NEPHROLOGY ASSOCIATES OF SPARTANBURG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES OF SPARTANBURG, LLC
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:
SPARTANBURG NEPHROLOGY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1437108461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 N PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29302-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-582-5099
Provider Business Mailing Address Fax Number:
864-327-1098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 N PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29302-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-5099
Provider Business Practice Location Address Fax Number:
864-327-1098
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANCASTER
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
864-582-5099

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5907795 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8516 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DE7625 . This is a "RAIL ROAD MEDICARE GRP#" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP4404 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20053685 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP4718 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5903663 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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