Prisma Health-Upstate
Organization Active NPI PACE Provider Organization · Greenville, SC
NPI 1407301302 · NPPES record last updated Jan 28, 2025
Key facts
- NPI
- 1407301302
- Entity type
- Organization (NPI type 2)
- Primary specialty
- PACE Provider Organization 251T00000X
- Legal business name
- PRISMA HEALTH-UPSTATE
- Practice address
- 32 Stoney Point Dr
Greenville, SC 29605-4628 - Phone
- (864) 522-1950
- NPI assigned
- Aug 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Polly Miller
- Title
- SVP Fin-Enterprise Payor Contractin
- Phone
- (864) 522-2286
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Upstate Affiliate Org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| PACE Provider Organization | 251T00000X | Yes |
Addresses
Primary practice location
32 Stoney Point Dr
Greenville, SC 29605-4628
Mailing address
300 E McBee Ave
Greenville, SC 29601-2842
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H4053 | Other | SC | CMS PACE PROGRAM |
| EX1649 | Medicaid | SC |
Other names
- Prisma Health Senior Care
Other providers in Greenville, SC
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
All providers in Greenville, SC · PACE Provider Organization 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 Jan 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.