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PRISMA HEALTH-UPSTATE NPI 1134512395


NPI Information

NPI: 1134512395
Provider Name: PRISMA HEALTH-UPSTATE

Doing Business As: PRISMA HEALTH ADVANCED FAMILY MEDICINE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 42D2119172

Address:
210 S BROAD ST
CLINTON, SC
ZIP 29325
Phone: (864) 833-0973
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PRISMA HEALTH-UPSTATE is a rural health clinic center in Clinton, SC. PRISMA HEALTH-UPSTATE NPI is 1134512395. The provider is registered as an organization entity type.
The provider Is Doing Business As Prisma Health Advanced Family Medicine.

The provider's business location address is:

210 S BROAD ST
CLINTON, SC
ZIP 29325-505
Phone: (864) 833-0973
Fax: (864) 833-9571

The provider's authorized official is Polly H. Miller .
The authorized official title is Vp Payor Strategies & Alignment and has the following contact phone number (864) 522-2286.

The CLIA number assigned to this NPI record is 42D2119172 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/12/2015 and was last updated on 2/4/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
1261QR1300XClinic/CenterRural HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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