NPIMap

Organization Active NPI

Spartanburg Regional Med Ctr

Doing business as Palmetto Pediatrics Village of Pelham

  • Pediatrics Physician
  • Greer, SC
National Provider Identifier
1699716431
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SPARTANBURG REGIONAL MED CTR
Doing business as
Palmetto Pediatrics Village of Pelham
Practice address
2755 S Highway 14
Suite 1200E
Greer, SC 29650-4902
Phone
(864) 849-9150
Fax
(864) 560-4413
NPI assigned
Jun 10, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Janice U Fowler
Title
Credentialing Specialist
Phone
(864) 560-4475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2755 S Highway 14
Suite 1200E
Greer, SC 29650-4902

Mailing address

PO Box 2168
Spartanburg, SC 29304
Phone (864) 560-4304

Other identifiers 1

IdentifierTypeStateIssuer
GP1118MedicaidSC

Other names 1

  • PALMETTO PEDIATRICS VILLAGE OF PELHAM Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Harriett Goodrich PA136 organizations share this tax ID, including this one
Part of
Spartanburg Regional Health Services District Inc

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

Locations

2755 S Highway 14
Ste 1200E
Greer, SC 29650
Phone (864) 849-9150

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1699716431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2168",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "29304",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 S HIGHWAY 14",
            "address_2": "SUITE 1200E",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296504902",
            "telephone_number": "864-849-9150",
            "fax_number": "864-560-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG REGIONAL MED CTR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT INC",
        "enumeration_date": "2006-06-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "864-560-4475"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1118",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PALMETTO PEDIATRICS VILLAGE OF PELHAM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greer, 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.

Verify at the official NPI Registry.