Basic Information
Provider Information | |||||||||
NPI: | 1720006596 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BILLINGS | ||||||||
FirstName: | MICHEAL | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 255 ENTERPRISE BLVD | ||||||||
Address2: | SUITE 250 | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296156300 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8644540888 | ||||||||
FaxNumber: | 8644541130 | ||||||||
Practice Location | |||||||||
Address1: | 701 GROVE RD | ||||||||
Address2: | GREENVILLE MEMORIAL ,ER ADMINISTRATION | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296055611 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8644556372 | ||||||||
FaxNumber: | 8644555474 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2006 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 14337 | SC | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 143375 | 05 | SC |   | MEDICAID | AB8719924 | 01 | SC | FEDERAL DEA | OTHER | 167143 | 01 | SC | UNISON | OTHER | 20009859 | 01 | SC | SELECT HEALTH IND | OTHER | 20-14337 | 01 | SC | SC CONTOLLED SUBSTANCE | OTHER | 20031678 | 01 | SC | SELECT HEALTH GRP | OTHER |