Organization
SPARTANBURG REGIONAL MEDICAL CTR
Active
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC
Other names
Village Orthopaedic Surgery-Mauldin
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC
Authorized official
MARK AYCOCK (EXECUTIVE VICE PRESIDENT)
(864) 560-6000
Entity
Organization
Contact information
Practice address
535 W BUTLER RD STE C, GREENVILLE, SC 29607-4833
(864) 277-9867
(864) 849-9394
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN1627
MEDICARE RR
SC
05
—
GP1118
—
SC
Enumeration date
10/28/2008
Last updated
07/29/2011
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