Active NPI
Palmetto Health Alliance Easley
- Family Medicine Physician
- Greenville, SC
National Provider Identifier
1568412476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- PALMETTO HEALTH ALLIANCE EASLEY
- Practice address
- 15 Roe Rd
Greenville, SC 29611-7423 - Phone
- (864) 295-2308
- Fax
- (864) 295-2635
- NPI assigned
- May 11, 2006
- Organization subpart
- Yes
- Parent organization
- PALMETTO HEALTH ALLIANCE EASLEY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kendall Durham
- Title
- Patient Financial Manager
- Phone
- (864) 855-5104
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
15 Roe Rd
Greenville, SC 29611-7423
Mailing address
PO Box 2089
Easley, SC 29641-2089
Phone (864) 855-5104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2174 | Medicaid | SC |
Other names 1
- Powdersville Medical Park
National Provider Directory
National Provider Directory- Part of
- Markowitz and Associates
Locations
15 Roe Rd
Greenville, SC 29611
Phone (864) 295-2308
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208649600000",
"number": "1568412476",
"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 RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296117423",
"telephone_number": "864-295-2308",
"fax_number": "864-295-2635"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PALMETTO HEALTH ALLIANCE EASLEY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PALMETTO HEALTH ALLIANCE EASLEY",
"enumeration_date": "2006-05-11",
"last_updated": "2008-04-20",
"status": "A",
"authorized_official_last_name": "DURHAM",
"authorized_official_first_name": "KENDALL",
"authorized_official_title_or_position": "PATIENT FINANCIAL MANAGER",
"authorized_official_telephone_number": "864-855-5104",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP2174",
"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 Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.