Organization
PRISMA HEALTH-UPSTATE
Active
Other names
Prisma Health Mountain Lakes Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
POLLY H. MILLER (VP PAYOR STRATEGIES & ALIGNMENT)
(864) 522-2286
Entity
Organization
Contact information
Practice address
10110 CLEMSON BLVD, SENECA, SC 29678-0812
(864) 482-3148
(864) 482-0505
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 455-7000
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/10/2019
Last updated
02/05/2021
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