1417076373 NPI number — JAMES SPENCER GAINEY MD

Table of content: JAMES SPENCER GAINEY MD (NPI 1417076373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417076373 NPI number — JAMES SPENCER GAINEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINEY
Provider First Name:
JAMES
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1417076373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3516 HIGHWAY 153
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:
29611-7553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-729-6626
Provider Business Mailing Address Fax Number:
855-617-4425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29334-9218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-984-0773
Provider Business Practice Location Address Fax Number:
864-984-0783
Provider Enumeration Date:
03/29/2007

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: 207Q00000X , with the licence number:  27902 , 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: 279022 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5918957 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00980727 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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