1770903833 NPI number — GREENVILLE HEALTH SYSTEM

Table of content: (NPI 1770903833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770903833 NPI number — GREENVILLE HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENVILLE HEALTH SYSTEM
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:
GHS SURGERY/ORTHOPEDICS CLINIC
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:
1770903833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/05/2015
NPI Reactivation Date:
01/15/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 INDEPENDENCE PT STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-797-6306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 EDGEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-455-8879
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RIORDAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
864-455-7978

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL-343 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111717 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42D0665869 . This is a "CLIA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CB9553 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CD7464 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: CI4624 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP2859 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 354643 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400783 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6510325 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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