| Upstate Gastroenterology, Pa | |
|
1922a Mcconnell Springs Rd Anderson SC 29621-2642 | |
| (864) 716-6050 | |
| (864) 716-6055 |
| Full Name | Upstate Gastroenterology, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1922a Mcconnell Springs Rd, Anderson, South Carolina |
| Authorized Official Name and Position | David T Wortham (MD) |
| Authorized Official Contact | 8647166050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upstate Gastroenterology, Pa 1922a Mcconnell Springs Rd Anderson SC 29621-2642 Ph: (864) 716-6050 | Upstate Gastroenterology, Pa 1922a Mcconnell Springs Rd Anderson SC 29621-2642 Ph: (864) 716-6050 |
| NPI Number | 1851342067 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 07/14/2011 |
| Medicare PECOS PAC ID | 3173518297 |
|---|---|
| Medicare Enrollment ID | O20040419000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851342067 | NPI | - | NPPES |
| GP3878 | Medicaid | SC | |
| DB7162 | Other | SC | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | David T Wortham |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437101771 PECOS PAC ID: 0941102073 Enrollment ID: I20040419000396 |
| Provider Name | Amanda Brooke Couch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700042520 PECOS PAC ID: 3072652494 Enrollment ID: I20091124000681 |
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