| Aid Upstate | |
|
811 Pendleton St Suite 11 Greenville SC 29601-3209 | |
| (864) 250-0607 | |
| (864) 250-0608 |
| Full Name | Aid Upstate |
|---|---|
| Speciality | Clinic/Center |
| Location | 811 Pendleton St, Greenville, South Carolina |
| Authorized Official Name and Position | Beaty Andrew Hall (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8642500607 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aid Upstate Po Box 105 Greenville SC 29602-0105 Ph: (864) 250-0607 | Aid Upstate 811 Pendleton St Suite 11 Greenville SC 29601-3209 Ph: (864) 250-0607 |
| NPI Number | 1023563459 |
|---|---|
| Provider Enumeration Date | 08/15/2016 |
| Last Update Date | 06/03/2024 |
| Medicare PECOS PAC ID | 2961783238 |
|---|---|
| Medicare Enrollment ID | O20161228000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023563459 | NPI | - | NPPES |
| GP7542 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
| Provider Name | John Henry Schrank |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1194777821 PECOS PAC ID: 8426031428 Enrollment ID: I20040610001112 |
| Provider Name | Douglas Patrick Mccormick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972576213 PECOS PAC ID: 7012990039 Enrollment ID: I20040610001222 |
| Provider Name | Lori L Malvern |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578663498 PECOS PAC ID: 5092819821 Enrollment ID: I20070403000447 |
| Provider Name | Heather Swofford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841639051 PECOS PAC ID: 7416190798 Enrollment ID: I20130905000802 |
| Provider Name | Prerana Jain Roth |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1548434863 PECOS PAC ID: 5991938946 Enrollment ID: I20140429001062 |
| Provider Name | Joseph B Halliday |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134357692 PECOS PAC ID: 6406070069 Enrollment ID: I20150102001027 |
| Provider Name | Lazedra Monah Myisha Cade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043860562 PECOS PAC ID: 7911330220 Enrollment ID: I20191127000214 |
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