Provider Demographics
NPI:1275366874
Name:UPSTATE PRIMARY CARE MEDICINE LLC
Entity type:Organization
Organization Name:UPSTATE PRIMARY CARE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-345-0832
Mailing Address - Street 1:810 POWDERSVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3704
Mailing Address - Country:US
Mailing Address - Phone:864-551-2764
Mailing Address - Fax:864-307-9322
Practice Address - Street 1:810 POWDERSVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3704
Practice Address - Country:US
Practice Address - Phone:864-551-2764
Practice Address - Fax:864-307-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty