Provider Demographics
| NPI: | 1518998038 |
|---|---|
| Name: | SPARTANBURG MEDICAL CENTER |
| Entity type: | Organization |
| Organization Name: | SPARTANBURG MEDICAL CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BRUCE |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | DAVIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 864-560-6000 |
| Mailing Address - Street 1: | PO BOX 277723 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ATLANTA |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30384-7723 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 864-560-4123 |
| Mailing Address - Fax: | 864-560-4023 |
| Practice Address - Street 1: | 101 E WOOD ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SPARTANBURG |
| Practice Address - State: | SC |
| Practice Address - Zip Code: | 29303-3040 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 864-560-4540 |
| Practice Address - Fax: | 864-560-4726 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-07-05 |
| Last Update Date: | 2024-08-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207RI0200X, 207V00000X, 2085N0700X, 2085R0202X, 2085R0204X, 207RI0011X, 208600000X, 363A00000X, 363L00000X, 367500000X, 367A00000X, 207R00000X, 207RC0000X, 207RC0001X | ||
| SC | HTL-0125 | 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty | |
| No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| SC | 3365 | Other | MEDICARE PIN |
| SC | 400079 | Medicaid | |
| SC | 3365 | Medicare PIN |
