NPIMap

Organization Active NPI

Spartanburg Medical Center

  • Pediatrics Physician
  • Spartanburg, SC
National Provider Identifier
1104867845
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SPARTANBURG MEDICAL CENTER
Practice address
8311 Warren H Abernathy Hwy
Spartanburg, SC 29301-1249
Phone
(864) 562-5400
Fax
(864) 562-5430
NPI assigned
Jun 10, 2006
Organization subpart
Yes
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Bruce A Davis
Title
Chief Financial Officer
Phone
(864) 560-6000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

8311 Warren H Abernathy Hwy
Spartanburg, SC 29301-1249

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 1

IdentifierTypeStateIssuer
GP5627MedicaidSC

Other names 1

  • Medical Group of the Carolinas - Pediatrics - Westside Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0683347Medical Group of the Carolinas-Pediatrics-Westside8311 Warren H Abernathy Hwy, Spartanburg, SC 29301AccreditationJan 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
SRMC Subacute Care Phys136 organizations share this tax ID, including this one
Part of
Spartanburg Regional Health Services District Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

122 Dillon Dr
Spartanburg, SC 29307
Phone (864) 560-6345

167 Pierpont Ave
Spartanburg, SC 29303
Phone (864) 560-6287

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1104867845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8311 WARREN H ABERNATHY HWY",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293011249",
            "telephone_number": "864-562-5400",
            "fax_number": "864-562-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC",
        "enumeration_date": "2006-06-10",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "864-560-6000"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5627",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Group of the Carolinas - Pediatrics - Westside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.