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Organization
FOOTHILLS CARDIOTHORACIC, P.A.
Active
Organization
FOOTHILLS CARDIOTHORACIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC HARLAN PETTIT (BUSINESS MANAGER)
(864) 583-4420
Entity
Organization
Contact information
Practice address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 583-4420
(864) 542-1045
Mailing address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 583-4420
(864) 542-1045
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
14290
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7905834
MEDICAID
NC
05
—
TL3788
—
SC
Enumeration date
03/15/2006
Last updated
08/22/2020
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