Spartanburg Medical Center
Organization Active NPI Surgery Physician · Gaffney, SC
NPI 1396220554 · NPPES record last updated Dec 12, 2018
Key facts
- NPI
- 1396220554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- SPARTANBURG MEDICAL CENTER
- Practice address
- 840 W Floyd Baker Blvd Ste B
Gaffney, SC 29341-1845 - Phone
- (864) 585-6491
- Fax
- (864) 585-1368
- NPI assigned
- Oct 3, 2018
- 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) 560-6103
Other NPIs on the same Medicare enrollment 48
Corporate family (same tax ID) 24
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 |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
840 W Floyd Baker Blvd Ste B
Gaffney, SC 29341-1845
Mailing address
PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7628 | Other | SC | MEDICARE PIN |
| GP8583 | Medicaid | SC |
Other names
- Medical Group of the Carolinas - Division of Surgery - Gaffney
Other providers in Gaffney, 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 Gaffney, SC · Surgery 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 12, 2018. 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.