1083003065 NPI number — MS. STEPHANIE LAYNE SIMS NP-C

Table of content: MS. STEPHANIE LAYNE SIMS NP-C (NPI 1083003065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083003065 NPI number — MS. STEPHANIE LAYNE SIMS NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMS
Provider First Name:
STEPHANIE
Provider Middle Name:
LAYNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOWLING
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083003065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E WOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29303-3040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-569-7048
Provider Business Mailing Address Fax Number:
864-560-7353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E WOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-569-7048
Provider Business Practice Location Address Fax Number:
864-560-7353
Provider Enumeration Date:
01/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  19256 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP3096 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: SC51559068 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC5155J577 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC51556067 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC51556084 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC51558510 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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