NPIMap

Organization Active NPI

Palmetto Health Alliance

Doing business as Powdersville Medical Park

  • Family Medicine Physician
  • Greenville, SC
National Provider Identifier
1518170182
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PALMETTO HEALTH ALLIANCE
Doing business as
Powdersville Medical Park
Practice address
15 Roe Road
Greenville, SC 29611
Phone
(864) 295-2308
Fax
(864) 295-2635
NPI assigned
May 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kendall J Durham
Title
Financial Service Rep-Manager
Phone
(864) 855-5104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

15 Roe Road
Greenville, SC 29611

Mailing address

PO Box 2089
Easley, SC 29641-2089
Phone (864) 855-5104

Other identifiers 1

IdentifierTypeStateIssuer
DE1915MedicaidSC

Other names 1

  • Powdersville Medical Park Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Family Practi105 organizations share this tax ID, including this one

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518170182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2089",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296412089",
            "telephone_number": "864-855-5104",
            "fax_number": "864-859-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ROE ROAD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29611",
            "telephone_number": "864-295-2308",
            "fax_number": "864-295-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "FINANCIAL SERVICE REP-MANAGER",
        "authorized_official_telephone_number": "864-855-5104"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE1915",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powdersville Medical Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.