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Organization Active NPI

Spartanburg Regional Med Ctr

Doing business as Pediatric Nutrition and Special Needs

  • Pediatrics Physician
  • Boiling Springs, SC
National Provider Identifier
1710922703
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SPARTANBURG REGIONAL MED CTR
Doing business as
Pediatric Nutrition and Special Needs
Practice address
3941 Hwy 9
Ste B
Boiling Springs, SC 29316
Phone
(864) 585-2765
Fax
(864) 560-9450
NPI assigned
Jun 17, 2006
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
Mrs. Susan Bruce
Title
Credentialing Specialist
Phone
(864) 560-4057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

3941 Hwy 9
Ste B
Boiling Springs, SC 29316

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GP1118MedicaidSC

Other names 1

  • PEDIATRIC NUTRITION AND SPECIAL NEEDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Harriett Goodrich PA136 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": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710922703",
    "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": "293042168",
            "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": "3941 HWY 9",
            "address_2": "STE B",
            "city": "BOILING SPRINGS",
            "state": "SC",
            "postal_code": "29316",
            "telephone_number": "864-585-2765",
            "fax_number": "864-560-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG REGIONAL MED CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "864-560-4057",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "PEDIATRIC NUTRITION AND SPECIAL NEEDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boiling Springs, 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.