1013161520 NPI number — SPARTANBURG MEDICAL CENTER

Table of content: (NPI 1013161520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013161520 NPI number — SPARTANBURG MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPARTANBURG MEDICAL CENTER
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:
1013161520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4304
Provider Business Mailing Address Fax Number:
864-560-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 SERPENTINE DR
Provider Second Line Business Practice Location Address:
GIBBS CANCER CENTER
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-560-7050
Provider Business Practice Location Address Fax Number:
864-560-7057
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MEINKE
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
864-560-6000

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5950609 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP4991 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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