1710931100 NPI number — MR. RALPH EMERSON GREENE III CRNA

Table of content: MR. RALPH EMERSON GREENE III CRNA (NPI 1710931100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710931100 NPI number — MR. RALPH EMERSON GREENE III CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
RALPH
Provider Middle Name:
EMERSON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1710931100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
587 BAIRD COVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28734-1999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-369-8422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
362 S BARRINGTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29501-8668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-679-3781
Provider Business Practice Location Address Fax Number:
843-669-1995
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APRN351 , 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)





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