Organization
CHILDREN'S RESPIRATORY CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUY SAMUEL FASCIANA (OFFICE ADMINISTRATOR)
(864) 220-8000
Entity
Organization
Contact information
Practice address
58 BEAR DR, GREENVILLE, SC 29605-4458
(864) 220-8000
(864) 220-8009
Mailing address
58 BEAR DR, GREENVILLE, SC 29605-4458
(864) 220-8000
(864) 220-8009
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
11118
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DME653
MEDICAID DME
SC
Enumeration date
10/17/2007
Last updated
10/17/2007
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