1275546996 NPI number — GREENBRIER VMC LLC

Table of content: (NPI 1275546996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275546996 NPI number — GREENBRIER VMC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENBRIER VMC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GREENBRIER VALLEY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275546996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 MAPLEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONCEVERTE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-647-4411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 MAPLEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONCEVERTE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24970-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-647-4411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BREWER
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
877-892-9813

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CJ9984 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0106041003 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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