Medical Group Of The Carolinas - Gastroenterology - Spartanburg | |
853 North Church Street Suite 620 Spartanburg SC 29303-3040 | |
(864) 573-7511 | |
(864) 560-4413 |
Full Name | Medical Group Of The Carolinas - Gastroenterology - Spartanburg |
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Speciality | Internal Medicine |
Location | 853 North Church Street, Spartanburg, South Carolina |
Authorized Official Name and Position | Kenneth Meinke (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 8645606000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Medical Group Of The Carolinas - Gastroenterology - Spartanburg Po Box 743070 Atlanta GA 30374-3070 Ph: (864) 560-4304 | Medical Group Of The Carolinas - Gastroenterology - Spartanburg 853 North Church Street Suite 620 Spartanburg SC 29303-3040 Ph: (864) 573-7511 |
NPI Number | 1760423503 |
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Provider Enumeration Date | 06/10/2006 |
Last Update Date | 12/09/2014 |
Medicare PECOS PAC ID | 3072425297 |
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Medicare Enrollment ID | O20040503001385 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760423503 | NPI | - | NPPES |
7901613 | Medicaid | NC | |
GP1118 | Medicaid | SC | |
CN1627 | Other | SC | RAILROAD MEDICARE GROUP # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
Provider Name | Anita M Cox |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306801584 PECOS PAC ID: 5799727541 Enrollment ID: I20050523000939 |
Provider Name | Thomas M Montagne |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1326019316 PECOS PAC ID: 3779584057 Enrollment ID: I20070130000124 |
Provider Name | Mark A Lijewski |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1487625471 PECOS PAC ID: 7416959473 Enrollment ID: I20070205000612 |
Provider Name | Peter J Kobes |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1447222690 PECOS PAC ID: 0345316600 Enrollment ID: I20080910000367 |
Provider Name | Albert J Mossburg |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1730150723 PECOS PAC ID: 0345382917 Enrollment ID: I20100120000119 |
Provider Name | Haywood G France |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1023089000 PECOS PAC ID: 0446393599 Enrollment ID: I20100211000431 |
Provider Name | Andrew Dean Taber |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1376631739 PECOS PAC ID: 1052567435 Enrollment ID: I20120820000333 |
Provider Name | Melony Collins Fowler |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013267558 PECOS PAC ID: 2860643160 Enrollment ID: I20121114000452 |
Provider Name | Bennett H Bruckner |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1639270622 PECOS PAC ID: 6608973169 Enrollment ID: I20140806001729 |
Provider Name | Wesley H Fisher |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033581467 PECOS PAC ID: 7911209549 Enrollment ID: I20160113001425 |
Provider Name | Jaime Marcus Bright |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992170807 PECOS PAC ID: 9537464037 Enrollment ID: I20160222000997 |
Provider Name | Sarah Jones Halley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437512191 PECOS PAC ID: 4789975194 Enrollment ID: I20160615000727 |
Provider Name | Melody E Thomas |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114441458 PECOS PAC ID: 9436424967 Enrollment ID: I20171009001646 |
Provider Name | Janine Wright Bullman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417443805 PECOS PAC ID: 3072866896 Enrollment ID: I20181024003384 |
Provider Name | Patty Cykert |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285010843 PECOS PAC ID: 9537469804 Enrollment ID: I20190819002794 |
Provider Name | Kevin Michael Douglass |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1487003943 PECOS PAC ID: 0345528444 Enrollment ID: I20200526002296 |
Provider Name | Jonathan Douglas Tester |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891323457 PECOS PAC ID: 4486075595 Enrollment ID: I20200527003305 |
Provider Name | Michael Courtney Windham |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1861697740 PECOS PAC ID: 2668668393 Enrollment ID: I20200911000988 |
Provider Name | Tamara Mary Richardson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598335812 PECOS PAC ID: 6800298753 Enrollment ID: I20210714002355 |
Provider Name | Kristi Sargent |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811642473 PECOS PAC ID: 5991173395 Enrollment ID: I20221116000109 |
Provider Name | Kristy Reutlinger |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538845656 PECOS PAC ID: 9739542507 Enrollment ID: I20230825002860 |
Provider Name | Michael Beattie |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1306366133 PECOS PAC ID: 4688944697 Enrollment ID: I20230926000532 |
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