Organization
PRISMA HEALTH-UPSTATE
Active
Other names
Prisma Health Senior Care
Organization subpart
No
Provider details
NPI number
Authorized official
POLLY MILLER (SVP FIN-ENTERPRISE PAYOR CONTRACTIN)
(864) 522-2286
Entity
Organization
Contact information
Practice address
32 STONEY POINT DR, GREENVILLE, SC 29605-4628
(864) 522-1950
Mailing address
300 E MCBEE AVE, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EX1649
—
SC
01
—
H4053
CMS PACE PROGRAM
SC
Enumeration date
08/20/2016
Last updated
01/28/2025
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