Basic Information
| Provider Information | |||||||||
| NPI: | 1053385617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUIRAO | ||||||||
| FirstName: | LYNNETTE | ||||||||
| MiddleName: | JUMAQUIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 325 MEDICAL PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296502457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647979550 | ||||||||
| FaxNumber: | 8647979555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 27416 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00900021 | 01 | SC | RR MEDICARE | OTHER | 274161 | 05 | SC | MEDICAID |