Spartanburg Medical Center
Organization Active NPI Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician · Spartanburg, SC
NPI 1376137158 · NPPES record last updated Mar 23, 2021
Key facts
- NPI
- 1376137158
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X
- Legal business name
- SPARTANBURG MEDICAL CENTER
- Practice address
- 11 Doctors Park Dr Ste 220
Spartanburg, SC 29307-1008 - Phone
- (864) 253-8055
- Fax
- (864) 253-8126
- NPI assigned
- Feb 23, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.
Authorized official
- Name
- Kenneth J Meinke
- Title
- Chief Financial Officer
- Phone
- (864) 560-6000
Other NPIs on the same Medicare enrollment 45
Corporate family (same tax ID) 24
Practitioners 5
-
Michelle Rae Blair, NP-C
-
Joey Edward Roque, M.D.
-
Grantham Dewitt Warren, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2215252 | Medical Group of the Carolinas- Urogynecology | Certificate of waiver | Apr 18, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040702000686 | SC | Part B Supplier - Clinic/Group Practice | 3072425297 |
Receives reassigned benefits from 808 practitioners 45 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Spartanburg, SC; Greer, SC; Travelers Rest, SC; Union, SC; Whitmire, SC; Drayton, SC; Gaffney, SC; Gray Court, 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 |
|---|---|---|---|---|
| Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician |
207VF0040X | Yes |
Addresses
Primary practice location
11 Doctors Park Dr Ste 220
Spartanburg, SC 29307-1008
Mailing address
PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5019 | Other | SC | MEDICARE PIN |
| PG0310 | Medicaid | SC |
Other names
- Medical Group of the Carolinas - Urogynecology
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 · Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) 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 Mar 23, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.