# SPARTANBURG REGIONAL MED CTR

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC
- **Other names:** Pediatric Ophthalmology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1972607059
- **Legal business name:** SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC
- **Authorized official:** GINA MICHELLE HILLERS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (864) 560-4057

## Contact information

- **Practice address:** 101 E WOOD ST, SPARTANBURG, SC 29303-3040
- **Practice address phone:** (864) 560-4304
- **Practice address fax:** (864) 560-4413
- **Mailing address:** PO BOX 2168, SPARTANBURG, SC 29304-2168
- **Mailing address phone:** (864) 560-4057
- **Mailing address fax:** (864) 560-4413

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2006
- **Last updated:** 10/25/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP1118 | — | SC |