1245650381 NPI number — GREENVILLE HEALTH SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245650381 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:
Provider Other Organization Name Type Code:
6
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:
1245650381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2015
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
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615-4545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-797-6400
Provider Business Mailing Address Fax Number:
864-797-6198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MEDICAL RIDGE 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:
29605-4267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-220-7270
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:
864-797-7808

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL343 , 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: 354643 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI4624 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 400783 , 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: GP2859 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6510325 . This is a "AETNA ID" 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: 111717 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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