Organization Active NPI

Plastic Surgery Associates of Greenville LLC

  • Plastic and Reconstructive Surgery Physician
  • Greenville, SC
National Provider Identifier
1104026541
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
9152 Issued in SC
Legal business name
PLASTIC SURGERY ASSOCIATES OF GREENVILLE LLC
Practice address
24 Memorial Medical Dr
Greenville, SC 29605-4452
Phone
(864) 295-4160
NPI assigned
Jul 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rhonda Norris
Title
Office Manager
Phone
(864) 295-4160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X 9152 SC Primary

Addresses

Primary practice location

24 Memorial Medical Dr
Greenville, SC 29605-4452

Mailing address

24 Memorial Medical Dr
Greenville, SC 29605-4452
Phone (864) 295-4160

Other identifiers 1

IdentifierTypeStateIssuer
PC1798MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1104026541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054452",
            "telephone_number": "864-295-4160",
            "fax_number": "864-295-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054452",
            "telephone_number": "864-295-4160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLASTIC SURGERY ASSOCIATES OF GREENVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-295-4160"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "SC",
            "license": "9152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC1798",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.