DAVITA UPSTATE DIALYSIS (NPI# 1114149614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114149614 |
| Entity Type | Organization |
| Organization Name | DAVITA UPSTATE DIALYSIS |
| Other Organization Name | UPSTATE DIALYSIS #382 |
| Practice Address |
308 Mills Avenue Greenville SC 29605 |
| Practice Telephone | 8642713700 |
| Practice Fax Number | 8642717929 |
| Mailing Telephone | 8642713700 |
| Mailing Fax Number | 8642717929 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. CYNTHIA J. GAYLE (FACILITY ADMINISTRATOR) |
| Authorized Official Telephone | 8642713700 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WD1100X |
Registered Nurse Specialization: Dialysis, Peritoneal |
ERD-098 | SC | Nursing Service Providers |
| Other Name | Type Code |
|---|---|
| Upstate Dialysis #382 | Other Name - Individual/Organization |
| Street Address |
308 MILLS AVENUE |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205306099 | Prisma Health University Medical Group | Family Medicine | 110 Osage Drive, Greenville, SC 29605 | 2018-12-05 |
| 1306325626 | Lauren Foster Fiscus | Occupational Therapist | 1900 Augusta Street, Suite 2500, Greenville, SC 29605 | 2018-08-08 |
| 1063914372 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 1720 Augusta St, Greenville, SC 29605 | 2018-03-02 |
| 1144748385 | Johanna Ruth Henry | Speech-Language Pathologist | 1900 Augusta St., Suite 2500, Greenville, SC 29605 | 2017-09-08 |
| 1477083483 | Alexis Dean Pedigo | Speech-Language Pathologist | 1900 Augusta St, Suite 2500, Greenville, SC 29605 | 2017-06-13 |
| 1134658420 | Trace Christopher Deighan | Obstetrics & Gynecology | 890 West Faris Road, Suite 470, Greenville, SC 29605 | 2017-06-08 |
| 1023569837 | Blessed With Goodness, LLC | In Home Supportive Care | 716 E. Fairfield Road, Unit 120 (mailbox # 14), Greenville, SC 29605 | 2016-10-17 |
| 1972050953 | Suha Umina | Pharmacist | 975 W. Faris Road, Greenville, SC 29605 | 2016-09-07 |
| 1124470976 | Meredith Laine Cavagrotti | Specialist/Technologist | 700 Grove Rd, Greenville, SC 29605 | 2016-07-05 |
| 1205286895 | Med-trans Corporation | Ambulance | 552 Perimeter Rd, Greenville, SC 29605 | 2016-06-15 |
| Find all providers in zip 29605 | ||||
| Taxonomy Code | 163WD1100X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Dialysis, Peritoneal |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902440381 | Alinda Pauline King-benjamin | Registered Nurse | 130 Mountain Maple Ln, Blythewood, SC 29016-7233 | 2019-10-29 |
| 1306375647 | Kimberly Shannon Arnold | Registered Nurse | 109 Bee St, Charleston, SC 29401-5703 | 2017-06-09 |
| City | GREENVILLE |
| Zip Code | 29605 |
Please comment or provide details below to improve the information on DAVITA UPSTATE DIALYSIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.