Basic Information
Provider Information | |||||||||
NPI: | 1700152543 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YUSI | ||||||||
FirstName: | KURT | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 262 | ||||||||
Address2: |   | ||||||||
City: | ANDERSON | ||||||||
State: | SC | ||||||||
PostalCode: | 296220262 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8645121440 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 480 FLOYD RD STE A | ||||||||
Address2: |   | ||||||||
City: | SPARTANBURG | ||||||||
State: | SC | ||||||||
PostalCode: | 293071518 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8645822188 | ||||||||
FaxNumber: | 8645822117 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/27/2012 | ||||||||
LastUpdateDate: | 05/29/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/29/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 131030 | CA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | 81552 | SC | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 815522 | 05 | SC |   | MEDICAID | SCE2647628 | 01 | SC | MEDICARE PIN | OTHER |