UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN (DIVISION OF REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY) - NPI NUMBER 1710944749

Summary

Provider Name: UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN (DIVISION OF REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY)

NPI Number: 1710944749

Clasification: Clinic/Center (261QM1300X)

Specialization: Multi-Specialty

Address:
890 W FARIS RD
SUITE 470
GREENVILLE, SC
ZIP 29605

Phone Number: (864) 455-1600



Detailed Information

UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN is a multi-specialty clinic/center in Greenville, SC. The assigned NPI number for this provider is 1710944749 and is registered as an organization entity type.
The provider Is Doing Business As Division Of Reproductive Endocrinology & Infertility.

The provider's business address is:

890 W FARIS RD
SUITE 470
GREENVILLE, SC
ZIP 29605-247
Phone: (864) 455-1600
Fax: (864) 455-3095

The provider's authorized official is Paul Bruce Miller .
The authorized official title is Staff Physician and has the following contact phone number (864) 455-1600.

The enumeration date for this NPI number is 4/26/2006 and was last updated on 7/9/2007.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM1300X Clinic/Center Multi-Specialty 19348 SC Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 193481 MEDICAID SC
2 G61701 MEDICARE UPIN SC

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1710944749 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name UNIVERSITY MEDICAL GROUP DEPARTMENT OF OBGYN The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name DIVISION OF REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 890 W FARIS RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE 470 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name GREENVILLE The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name SC The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 296054247 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 8644551600 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 8644553095 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 4/26/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 7/9/2007 The date that a record was last updated or changed.
17 Authorized Official Last Name MILLER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name PAUL The first name of the authorized official.
19 Authorized Official Middle Name BRUCE The middle name of the authorized official.
20 Authorized Official Title or Position STAFF PHYSICIAN The title or position of the authorized official.
21 Authorized Official Telephone Number 8644551600 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 261QM1300X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
23 Provider License Number 1 19348 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
24 Provider License Number State Code 1 SC The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 1 Y
26 Other Provider Identifier 1 193481 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 1 SC
29 Other Provider Identifier 2 G61701 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 2 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 2 SC
32 Authorized Official Name Prefix Text DR.
33 Authorized Official Credential Text MD

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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