Spartanburg Medical Center
Organization Active NPI Family Medicine Physician · Roebuck, SC
NPI 1659840932 · NPPES record last updated Mar 11, 2019
Key facts
- NPI
- 1659840932
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SPARTANBURG MEDICAL CENTER
- Practice address
- 5229 Highway 221
Roebuck, SC 29376-3305 - Phone
- (864) 576-8193
- Fax
- (864) 576-8952
- NPI assigned
- Nov 16, 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 18
Corporate family (same tax ID) 24
Practitioners 3
-
Vincent C Slater, D.O.
-
Heather Stokes, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0903848 | Medical Group of the Carolinas - Dorman | Accreditation | Sep 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322000577 | SC | Part B Supplier - Clinic/Group Practice | 3072425297 |
Receives reassigned benefits from 205 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gaffney, SC; Woodruff, SC; Spartanburg, SC; Roebuck, SC; Pacolet, SC; Inman, SC; Greenville, SC; Boiling Springs, SC |
National Provider Directory
- Tax ID family
- SRMC Subacute Care Phys
- Part of
- Spartanburg Regional Health Services District Inc
Locations
517 Chesnee Hwy
#A
Gaffney, SC 29341
Phone (864) 487-7655
5229 Highway 221
Roebuck, SC 29376
Phone (864) 576-8193
1330 Boiling Springs Rd
Ste 2500
Spartanburg, SC 29303
Phone (864) 585-5433
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
5229 Highway 221
Roebuck, SC 29376-3305
Mailing address
PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP8758 | Medicaid | SC | |
| 6084 | Other | SC | MEDICARE PIN |
Other names
- Medical Group of the Carolinas - Family Medicine - Dorman
Other providers in Roebuck, SC
- Michael Sobeski Sr.
- Solo Flyer, Inc.
- Southern Care Providers, LLC
- Spartan Health Services, Inc.
- Spartanburg County School District Six
- Jaime P. Steading
- John Leroy Steele Jr.
- Beverly Gail Stephenson
- Allison Varney
- Adriana R Velez
All providers in Roebuck, SC · Family Medicine 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 11, 2019. 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.