Basic Information
| Provider Information | |||||||||
| NPI: | 1649421538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GHS PARTNERS IN HEALTH,INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAURENS FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
| FaxNumber: | 8647976198 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | LAURENS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293602652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649840571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | BICHEL | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 8644558978 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP1560 | 05 | SC | MEDICAID |