Provider Demographics
NPI:1699964569
Name:CHILDREN'S RESPIRATORY CENTER, PA
Entity type:Organization
Organization Name:CHILDREN'S RESPIRATORY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:FASCIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-220-8000
Mailing Address - Street 1:58 BEAR DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4458
Mailing Address - Country:US
Mailing Address - Phone:864-220-8000
Mailing Address - Fax:864-220-8009
Practice Address - Street 1:58 BEAR DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4458
Practice Address - Country:US
Practice Address - Phone:864-220-8000
Practice Address - Fax:864-220-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC111182080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME653OtherMEDICAID DME