NPIMap

Organization Active NPI

Spartanburg Medical Center

  • Customized Equipment (DME)
  • Spartanburg, SC
National Provider Identifier
1114017688
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
SPARTANBURG MEDICAL CENTER
Practice address
380 Serpentine Dr
Suite 109
Spartanburg, SC 29303-3066
Phone
(864) 560-7080
Fax
(864) 560-7077
NPI assigned
Oct 13, 2006
Organization subpart
Yes
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kenneth Meinke
Title
Chief Financial Officer
Phone
(864) 560-6000

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 1,060

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

View all 1,060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110713000839 SC DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 3072425297 Practice locations: Spartanburg, SC

All facility ownership & control disclosures 5

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Spartanburg Medical CenterSpartanburg, SC, CCN 420007 Hospital Operational/Managerial Control Nov 27, 2007
Spartanburg Medical CenterSpartanburg, SC, CCN 42S007 Hospital Operational/Managerial Control Nov 27, 2007
Spartanburg Medical CenterSpartanburg, SC, CCN 42T007 Hospital Operational/Managerial Control Nov 27, 2007
Spartanburg Regional HospiceSpartanburg, SC, CCN 421500 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 1995
May 1, 1995
CMC - Center for OB/GYNGaffney, SC, CCN 423492 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2021

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X Primary

Addresses

NPPES NPI Registry

Primary practice location

380 Serpentine Dr
Suite 109
Spartanburg, SC 29303-3066

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
DME865MedicaidSC

Other names 1

NPPES NPI Registry
  • That Special Look Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 28, 2016.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1114017688",
    "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": "380 SERPENTINE DR",
            "address_2": "SUITE 109",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033066",
            "telephone_number": "864-560-7080",
            "fax_number": "864-560-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC",
        "enumeration_date": "2006-10-13",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "MEINKE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "864-560-6000"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME865",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "That Special Look",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.