Provider Demographics
NPI:1538342019
Name:JAMES C MENSONE MD
Entity type:Organization
Organization Name:JAMES C MENSONE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CAESAR
Authorized Official - Last Name:MENSONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-297-4093
Mailing Address - Street 1:10 ENTERPRISE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3534
Mailing Address - Country:US
Mailing Address - Phone:864-297-4093
Mailing Address - Fax:864-297-4095
Practice Address - Street 1:10 ENTERPRISE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3534
Practice Address - Country:US
Practice Address - Phone:864-297-4093
Practice Address - Fax:864-297-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB91452Medicare UPIN
SC8157Medicare PIN