SPARTANBURG MEDICAL CENTER (NPI# 1407325509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407325509 |
| Entity Type | Organization |
| Organization Name | SPARTANBURG MEDICAL CENTER |
| Other Organization Name | MEDICAL GROUP OF THE CAROLINAS-GASTROENTEROLOGY -SKYLYN |
| Practice Address |
11 Doctors Park Dr Ste 240 Spartanburg SC 29307-1008 |
| Mailing Address |
Po Box 743070 Atlanta GA 30374-3070 |
| Practice Telephone | 8643424115 |
| Practice Fax Number | 8643424064 |
| Mailing Telephone | 8645604304 |
| Mailing Fax Number | 8645604413 |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2019-03-13 |
| Authorized Official Name | KENNETH J MEINKE (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 8645606103 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP8759 | 05 | |
| SC | MEDICARE PIN | 5206 | 01 |
| Other Name | Type Code |
|---|---|
| Medical Group of the Carolinas-Gastroenterology -Skylyn | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386205094 | Spartanburg Medical Center | Pediatrics | 575 Ingles Dr Ste A, Inman, SC 29349-8314 | 2019-06-24 |
| 1780248211 | Spartanburg Medical Center | Urology | 2755 S Highway 14 Ste 2050a, Greer, SC 29650-4902 | 2019-04-30 |
| 1205499217 | Spartanburg Medical Center | Internal Medicine | 104 Professional Park Ste C, Gaffney, SC 29340-2319 | 2019-04-16 |
| 1649735127 | Spartanburg Medical Center | Family Medicine | 11 Doctors Park Dr Ste 200, Spartanburg, SC 29307-1008 | 2019-02-08 |
| 1316416415 | Spartanburg Medical Center | Orthopaedic Surgery | 1650 Skylyn Dr Ste 120, Spartanburg, SC 29307-1069 | 2018-11-19 |
| 1609345982 | Spartanburg Medical Center | Urology | 1552 N Limestone St Ste A, Gaffney, SC 29340-4750 | 2018-11-16 |
| 1316416688 | Spartanburg Medical Center | Internal Medicine | 104 Professional Park Ste B, Gaffney, SC 29340-2319 | 2018-11-16 |
| 1396220554 | Spartanburg Medical Center | Surgery | 840 W Floyd Baker Blvd Ste B, Gaffney, SC 29341-1845 | 2018-10-03 |
| 1114432077 | Spartanburg Medical Center | Orthopaedic Surgery | 2755 S Highway 14 Ste 1200m, Greer, SC 29650 | 2017-12-13 |
| 1518498336 | Spartanburg Medical Center | Family Medicine | 2846 N Old Laurens Rd, Gray Court, SC 29645-3157 | 2017-03-23 |
| Street Address |
11 DOCTORS PARK DR STE 240 |
| City | SPARTANBURG |
| State | SC |
| Zip Code | 29307-1008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639270622 | Bennett Howard Bruckner | Internal Medicine | 11 Doctors Park Dr Ste 240, Spartanburg, SC 29307-1008 | 2006-09-25 |
| 1417443805 | Janine Wright Bullman | Nurse Practitioner | 11 Doctors Park Dr Ste 240, Spartanburg, SC 29307-1008 | 2018-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023677945 | Healogics Specialty Physicians of South Carolina, LLC | Clinic/Center | 1630 Skylyn Drive, Suite 420, Spartanburg, SC 29307 | 2019-06-13 |
| 1194247528 | Tawnia Lee Prince | Occupational Therapy Assistant | 110 Summit Knoll Drive, Spartanburg, SC 29307 | 2017-07-07 |
| 1730633553 | Laura K Taylor | Chiropractor | 1802 Drayton Road, Suite 309, Spartanburg, SC 29307 | 2016-08-10 |
| 1013372390 | Erin Lavette Farr | Nurse Practitioner | 2780 East Main Street, Ltc Health Solutions, Spartanburg, SC 29307 | 2015-12-30 |
| 1316312010 | Joy Rogers | Speech-Language Pathologist | 175 Burdette St, Spartanburg, SC 29307 | 2015-12-07 |
| 1376923169 | Olivia Conrad | Speech-Language Pathologist | 220 Sloans Grove Rd, Spartanburg, SC 29307 | 2015-06-05 |
| 1457755118 | Optimal Radiology Partners of Virginia, Pllc | Radiology | 75 Skylyn Drive, Spartanburg, SC 29307 | 2014-10-09 |
| 1295033272 | Sean Quinn | Pharmacist | 790 East Main Street, Spartanburg, SC 29307 | 2011-03-01 |
| 1417250887 | James Edward Bradof | Internal Medicine | 212 Cypress Creek Drive, Spartanburg, SC 29307 | 2010-12-07 |
| 1528388030 | Tanya Tocharoen Tang | Internal Medicine | 126 Dillon Dr., Spartanburg, SC 29307 | 2010-06-07 |
| Find all providers in zip 29307 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083909402 | Andrew Jonathan Motlis | Internal Medicine | 853 N Church St Ste 620, Spartanburg, SC 29303-3070 | 2011-06-14 |
| 1639270622 | Bennett Howard Bruckner | Internal Medicine | 11 Doctors Park Dr Ste 240, Spartanburg, SC 29307-1008 | 2006-09-25 |
| 1407809296 | Albert George Fedalei | Internal Medicine | 11 Doctors Park Drive, Suite 240, Spartanburg, SC 29307-1008 | 2006-05-19 |
| 1568607190 | Mary Black Physicians Group, LLC | Internal Medicine | 11 Doctors Park Dr, Suite 240, Spartanburg, SC 29307-1024 | 2008-12-11 |
| 1760423503 | Spartanburg Medical Center | Internal Medicine | 853 North Church Street, Suite 620, Spartanburg, SC 29303-3040 | 2006-06-10 |
| 1447222690 | Peter J Kobes | Internal Medicine | 853 N Church St, Ste 620, Spartanburg, SC 29303-3040 | 2006-02-02 |
| 1962473777 | Walter James Douglass | Internal Medicine | 853 N Church St, Suite 620, Spartanburg, SC 29303-3098 | 2006-01-30 |
| 1730150723 | Albert Jurdan Mossburg | Internal Medicine | 853 N Church St, Suite 620, Spartanburg, SC 29303-3098 | 2006-01-30 |
| 1861463671 | Mitchell Hurst Allen | Internal Medicine | 853 N Church St, Suite 620, Spartanburg, SC 29303-3098 | 2006-01-30 |
| 1326019316 | Thomas Marcel Montagne | Internal Medicine | 853 N Church St, Suite 620, Spartanburg, SC 29303-3098 | 2006-01-30 |
| Find all providers in SPARTANBURG | ||||
| City | SPARTANBURG |
| Zip Code | 29307 |
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| 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.