PRISMA HEALTH-UPSTATE NPI 1205414828

NPI Information

  • NPI: 1205414828
  • Provider Name: PRISMA HEALTH-UPSTATE
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • Doing Business As: PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
  • CLIA Number: 42D2237543
  • Address: 200 N. NELSON DRIVE
    FOUNTAIN INN, SC
    ZIP 29644
  • Phone: (864) 522-6270

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NPI Details

PRISMA HEALTH-UPSTATE is a rural health clinic center in Fountain Inn, SC. PRISMA HEALTH-UPSTATE NPI is 1205414828. The provider is registered as an organization entity type.
The provider Is Doing Business As Prisma Health Primary Care Fountain Inn.

The provider's business location address is:

200 N. NELSON DRIVE
FOUNTAIN INN, SC
ZIP 29644
Phone: (864) 522-6270
Fax: (864) 522-6275

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 42D2237543 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/2/2021 and was last updated on 4/22/2022.

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: 11/21/2025

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