1871826743 NPI number — AMBULATORY MEDICINE ASSOCIATES, LLC

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 1871826743 NPI number — AMBULATORY MEDICINE ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULATORY MEDICINE ASSOCIATES, 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:
JORGE A. SABIN, MD & SALUDA LAKE MEDICAL CENTER
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:
1871826743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14489
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:
29610-4489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-294-1800
Provider Business Mailing Address Fax Number:
864-246-3251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 SULPHUR SPRINGS RD
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:
29617-6206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-294-1800
Provider Business Practice Location Address Fax Number:
864-246-3251
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SABIN
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
ALEJANDRO
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
864-294-1800

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD-26686 , 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)





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