| Prisma Health-upstate | |
|
200 N. Nelson Drive Fountain Inn SC 29644 | |
| (864) 522-6270 | |
| (864) 522-6275 |
| Full Name | Prisma Health-upstate |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 N. Nelson Drive, Fountain Inn, South Carolina |
| Authorized Official Name and Position | Polly H. Miller (VP, PAYOR STRATEGIES & ALIGNMENT) |
| Authorized Official Contact | 8645222286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prisma Health-upstate 300 E Mcbee Ave Fl 4 Greenville SC 29601-2842 Ph: (864) 522-8603 | Prisma Health-upstate 200 N. Nelson Drive Fountain Inn SC 29644 Ph: (864) 522-6270 |
| NPI Number | 1205414828 |
|---|---|
| Provider Enumeration Date | 04/02/2021 |
| Last Update Date | 04/22/2022 |
| Medicare PECOS PAC ID | 5698063162 |
|---|---|
| Medicare Enrollment ID | O20210422000284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205414828 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Prisma Health-upstate Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 N Nelson Dr, Fountain Inn, SC 29644 Phone: 864-522-6270 Fax: 864-522-6275 |