Basic Information
| Provider Information | |||||||||
| NPI: | 1841637790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTZ | ||||||||
| FirstName: | MACKENZIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E MCBEE AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645228615 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 403 HILLCREST DR STE C | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296401207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648551644 | ||||||||
| FaxNumber: | 8648556101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35707 | SC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 357072 | 05 | SC | MEDICAID | SCE2513365 | 01 | SC | MEDICARE PIN | OTHER | SCE2517628 | 01 | SC | MEDICARE PIN | OTHER |