Organization · Type 2 NPI

Prisma Health-Upstate

Rural Health Clinic/Center · Fountain Inn, SC

NPI number 1205414828 Active

Practice location

200 N. Nelson Drive
Fountain Inn, SC 29644

Call (864) 522-6270 Map

Fax (864) 522-6275

Mailing address

300 E Mcbee Ave Fl 4
Greenville, SC 29601-2842

Specialties and licenses

Taxonomy	Code	License
Rural Health Clinic/Center Primary	261QR1300X	None listed

Rural Health Clinic/Center: Definition to come...

NPI record

NPI: 1205414828
Entity type: Organization (Type 2)
Issued: Apr 2, 2021
Last updated: Apr 22, 2022
Status: Active

Other names

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Prisma Health Primary Care Fountain Inn · doing business as
Prisma Health Primary Care Fountain Inn · doing business as

Authorized official

Polly H. Miller
VP, Payor Strategies & Alignment
(864) 522-2286

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1205414828

Prisma Health-Upstate's National Provider Identifier is 1205414828, issued on Apr 2, 2021. The primary taxonomy on file is Rural Health Clinic/Center (261QR1300X), and the practice location is in Fountain Inn, SC. The record was last updated on Apr 22, 2022.