| Carolina Neurology Of Spartanburg | |
|
541 Floyd Rd Spartanburg SC 29307-1520 | |
| (864) 585-6179 | |
| (864) 585-5403 |
| Full Name | Carolina Neurology Of Spartanburg |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 541 Floyd Rd, Spartanburg, South Carolina |
| Authorized Official Name and Position | Carol Kooistra (PHYSICIAN) |
| Authorized Official Contact | 8645856179 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Neurology Of Spartanburg 541 Floyd Rd Spartanburg SC 29307-1520 Ph: (864) 585-6179 | Carolina Neurology Of Spartanburg 541 Floyd Rd Spartanburg SC 29307-1520 Ph: (864) 585-6179 |
| NPI Number | 1922345529 |
|---|---|
| Provider Enumeration Date | 01/16/2013 |
| Last Update Date | 03/27/2020 |
| Certification Date | 03/27/2020 |
| Medicare PECOS PAC ID | 1153564463 |
|---|---|
| Medicare Enrollment ID | O20130904001007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922345529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 13349 (South Carolina) | Primary |
| Provider Name | David D Wilt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083614739 PECOS PAC ID: 4385666262 Enrollment ID: I20051220000286 |
| Provider Name | Carol A Kooistra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598741837 PECOS PAC ID: 5890759328 Enrollment ID: I20071008000364 |
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