EGBERT VERNON ANDERSON JR. M.D.
Complete NPI Record 1275576357
Pediatrics in Greenville, SC

NPI Status: Active since June 14, 2006

Contact Information

3911 S HIGHWAY 14
GREENVILLE, SC
ZIP 29615
Phone: (864) 297-8890

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Complete NPI Dataset

The following table represents the complete dataset for NPI number 1275576357. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1275576357The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code1Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Last Name Legal NameANDERSONThe last name of the provider. If the provider is an individual, this is the legal name.
Provider First NameEGBERTThe first name of the provider, if the provider is an individual.
Provider Middle NameVERNONThe middle name of the provider, if the provider is an individual.
Provider Name Suffix TextJR.The name suffix of the provider if the provider is an individual. The name suffix is a ‘‘generation-related’’ suffix, such as Jr., Sr., II, III, IV, or V.
Provider Credential TextM.D.The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address1 INDEPENDENCE PTThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressSUITE 212The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameGREENVILLEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameSCThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code296154545The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8647976044The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address3911 S HIGHWAY 14The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameGREENVILLEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameSCThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code296156138The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number8642978890The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date6/14/2006The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date6/1/2024The date that a record was last updated or changed.
Provider Gender CodeMThe code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1208000000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 16444The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1SCThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1064441Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1SC
Other Provider Identifier 24556582Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 201Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2SC
Other Provider Identifier Issuer 2AETNA
Other Provider Identifier 31681141Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 301Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3SC
Other Provider Identifier Issuer 3CIGNA
Other Provider Identifier 457-1004971001Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 401Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4SC
Other Provider Identifier Issuer 4BCBS OF SC
Is Sole ProprietorNCode indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No