# PRISMA HEALTH-UPSTATE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prisma Health Pediatrics-Clemson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013698687
- **Authorized official:** POLLY H MILLER (SVP FINANCE ENTERPRISE CONTRACTING)
- **Authorized official phone:** (864) 522-2286

## Contact information

- **Practice address:** 450 OLD GREENVILLE HWY, CLEMSON, SC 29631-1670
- **Practice address phone:** (864) 653-8964
- **Practice address fax:** (864) 653-8963
- **Mailing address:** 300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
- **Mailing address phone:** (864) 522-2286

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/27/2023
- **Last updated:** 10/12/2023