Organization
SPARTANBURG REGIONAL MED CTR
Active
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT INC
Other names
REGIONAL FAMILY NEUROLOGY
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT INC
Authorized official
GINA MICHELLE HILLERS (CREDENTIALING SPECIALIST)
(864) 560-4057
Entity
Organization
Contact information
Practice address
853 N CHURCH STREET, SUITE 640, SPARTANBURG, SC 29303-3040
(864) 560-6445
(864) 560-4413
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57600934075
BLUE CROSS BLUE SHIELD G
SC
05
—
6906099
—
NC
01
—
CN1627
RAILROAD MEDICARE GROUP#
SC
05
—
GP2722
—
SC
Enumeration date
07/05/2006
Last updated
11/24/2008
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