Provider Demographics
NPI:1861235426
Name:PRISMA HEALTH-UPSTATE
Entity type:Organization
Organization Name:PRISMA HEALTH-UPSTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR-ENROLLMENT & CVO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-8611
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:803-522-2286
Mailing Address - Fax:
Practice Address - Street 1:157 WELBORN ST
Practice Address - Street 2:STE 100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601
Practice Address - Country:US
Practice Address - Phone:803-296-4829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRISMA HEALTH-UPSTATE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital