Provider Demographics
NPI:1386920593
Name:MINASI, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:MINASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAINT FRANCIS DR
Mailing Address - Street 2:ST 360
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3971
Mailing Address - Country:US
Mailing Address - Phone:864-233-4349
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT FRANCIS DR
Practice Address - Street 2:ST 360
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3971
Practice Address - Country:US
Practice Address - Phone:864-233-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA020000718OtherMEDICARE PROVIDER BILLING NUMBER
VA007377177Medicaid
VA007377177Medicaid