1629228382 NPI number — FAMILY PHYSICIANS OF SPARTANBURG, PC

Table of content: DR. DUC BA PHAN AUD (NPI 1063303840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629228382 NPI number — FAMILY PHYSICIANS OF SPARTANBURG, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHYSICIANS OF SPARTANBURG, PC
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:
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:
1629228382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3021 REIDVILLE ROAD
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:
29301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-576-9201
Provider Business Mailing Address Fax Number:
864-576-6584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021 REIDVILLE ROAD
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:
29301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-576-9201
Provider Business Practice Location Address Fax Number:
864-576-6584
Provider Enumeration Date:
09/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
864-576-9201

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9525 , 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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