Brunson, Jack Wade

Brunson, Jack Wade is an individual health care provider with primary practice located at 398 The Pkwy , Greer SC 29650-4569. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Brunson, Jack Wade can be contacted via phone (864) 877-9577.

Contact Information

Primary practice address
398 The Pkwy Greer SC 29650-4569
Phone: (864) 877-9577
Fax: (864) 877-9073
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 10099 South Carolina

Profile Details

NPI number 1316918253
LBN Legal business name Brunson, Jack Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Dec 8th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316918253 NPPES
South Carolina Other SCI6605019 MEDICARE PIN
South Carolina MEDICAID 100991 MEDICARE PIN
South Carolina Other SCI6606067 MEDICARE PIN

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