Organization
AID UPSTATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJEE RAO (CEO)
(864) 250-0607
Entity
Organization
Contact information
Practice address
811 PENDLETON ST, SUITE 11, GREENVILLE, SC 29601-3209
(864) 250-0607
(864) 250-0608
Mailing address
PO BOX 105, GREENVILLE, SC 29602-0105
(864) 250-0607
(864) 250-0608
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7542
—
SC
Enumeration date
08/15/2016
Last updated
12/02/2024
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