NPIMap

Organization Active NPI

Spartanburg Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Spartanburg, SC
National Provider Identifier
1811076623
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
ASF-026 Issued in SC
Legal business name
SPARTANBURG SURGERY CENTER, LLC
Practice address
391 Serpentine Dr Ste 200
Spartanburg, SC 29303
Phone
(864) 585-2002
NPI assigned
Nov 3, 2006
Last updated
Aug 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

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

Authorized official

Name
Mr. Alex Reynolds
Title
Board Member
Phone
(864) 585-2002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X ASF-026 SC Primary

Addresses

Primary practice location

391 Serpentine Dr Ste 200
Spartanburg, SC 29303

Mailing address

391 Serpentine Drive
Suite 200
Spartanburg, SC 29303-3079
Phone (864) 585-2002

Other identifiers 1

IdentifierTypeStateIssuer
Q292200001OtherMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041007000520 SC Part B Supplier - Ambulatory Surgical Center 6507844636 Practice locations: Spartanburg, SC

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Spartanburg Surgery Center LLCCCN 42C0001023
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

391 Serpentine Dr
Ste 330
Spartanburg, SC 29303
Phone (864) 585-2002

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1811076623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 SERPENTINE DRIVE",
            "address_2": "SUITE 200",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033079",
            "telephone_number": "864-585-2002",
            "fax_number": "864-585-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 SERPENTINE DR STE 200",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "29303",
            "telephone_number": "864-585-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "864-585-2002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SC",
            "license": "ASF-026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Q292200001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.