Provider Demographics
NPI:1114542081
Name:PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Entity type:Organization
Organization Name:PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-385-4790
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4211
Practice Address - Country:US
Practice Address - Phone:864-522-1439
Practice Address - Fax:864-522-1428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty