| Prisma Health-upstate | |
|
209 Three Bridges Rd Greenville SC 29611-7549 | |
| (864) 522-5500 | |
| (864) 241-9207 |
| Full Name | Prisma Health-upstate |
|---|---|
| Speciality | Clinic/Center |
| Location | 209 Three Bridges Rd, Greenville, South Carolina |
| Authorized Official Name and Position | Polly H. Miller (VP PAYOR STRATEGIES & ALIGNMENT) |
| Authorized Official Contact | 8645222286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prisma Health-upstate 300 E Mcbee Ave Fl 4 Greenville SC 29601-2842 Ph: (864) 455-7000 | Prisma Health-upstate 209 Three Bridges Rd Greenville SC 29611-7549 Ph: (864) 522-5500 |
| NPI Number | 1770167728 |
|---|---|
| Provider Enumeration Date | 05/06/2021 |
| Last Update Date | 05/06/2021 |
| Medicare PECOS PAC ID | 5698063162 |
|---|---|
| Medicare Enrollment ID | O20210708003658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770167728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Kayce Lynn Newbern Edwards |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295116994 PECOS PAC ID: 3779857487 Enrollment ID: I20191022000295 |
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