Provider Demographics
NPI:1760461404
Name:SYNERGY PHYSICIAN GROUP, PA
Entity type:Organization
Organization Name:SYNERGY PHYSICIAN GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-882-8850
Mailing Address - Street 1:457 E BY PASS 123
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0842
Mailing Address - Country:US
Mailing Address - Phone:864-886-9888
Mailing Address - Fax:864-886-9777
Practice Address - Street 1:457 E BY PASS 123
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0842
Practice Address - Country:US
Practice Address - Phone:864-886-9888
Practice Address - Fax:864-886-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3439Medicaid
SCGP3439Medicaid