Basic Information
| Provider Information | |||||||||
| NPI: | 1811312747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPSTATE SC EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S PARK RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330218593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 N LIMESTONE ST | ||||||||
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| City: | GAFFNEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293404742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644874271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2014 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHILLINGER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8008158377 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP6410 | 05 | SC | MEDICAID |