Spartanburg Medical Center
Organization Active NPI Psychiatry Physician · Spartanburg, SC
NPI 1295824159 · NPPES record last updated Dec 9, 2014
Key facts
- NPI
- 1295824159
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- SPARTANBURG MEDICAL CENTER
- Practice address
- 391 Serpentine Dr
Suite 400, Doctor'S Center
Spartanburg, SC 29303-3096 - Phone
- (864) 560-7517
- Fax
- (864) 560-7520
- NPI assigned
- Oct 11, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC
Authorized official
- Name
- Kenneth Meinke
- Title
- Chief Financial Officer
- Phone
- (864) 560-6000
Other NPIs on the same Medicare enrollment 48
Corporate family (same tax ID) 24
Practitioners 27
-
Fariya Faireen Ali, M.D.
-
Sheril Belizaire, MSN, APRN, AGACNP-BC
-
Amarinthia E Curtis, M.D.
-
Calvin A. Edmundson, LPC
-
Ryan Ashley Greene, M.D.
-
Jayme Hodges, LCSW / LISW-CP
-
Kristin Elena Klimbal, APRN
-
Jordan L Malray, MD
-
John Jay Mauch, DO
-
Deana Jo McReynolds, D.O.
-
Hana San Esteban, MD
-
Vanessa Thompson, PMHNP-GNP-BC
-
Brooke Ashley Wilcox, PMHNP
-
Craig Stephen Williams, PH.D.
-
Peter Wrzesinski, MD
-
Richard Boiter, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040108000827 | SC | Part B Supplier - Clinic/Group Practice | 3072425297 |
Receives reassigned benefits from 324 practitioners 48 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Spartanburg, SC; Union, SC; Simpsonville, SC; Boiling Springs, SC; Gaffney, SC; Greenville, SC; Greer, SC |
National Provider Directory
- Tax ID family
- SRMC Subacute Care Phys
- Part of
- Spartanburg Regional Health Services District Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician |
2084A0401X | |||
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
391 Serpentine Dr
Suite 400, Doctor'S Center
Spartanburg, SC 29303-3096
Mailing address
PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP1118 | Medicaid | SC | |
| 89014YV | Medicaid | NC | |
| CN1627 | Other | SC | RAILROAD MEDICARE GROUP # |
Other names
- Medical Group of the Carolinas - Psychiatry
Other providers in Spartanburg, SC
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
- Spartanburg Medical Center
All providers in Spartanburg, SC · Psychiatry Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.