1871663039 NPI number — GREENVILLE HOSPITAL

Table of content: (NPI 1871663039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871663039 NPI number — GREENVILLE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENVILLE HOSPITAL
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:
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:
1871663039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 MEADOWLANDS PKWY
Provider Second Line Business Mailing Address:
2ND FLOOR FINANCE DEPARTMENT
Provider Business Mailing Address City Name:
SECAUCUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07094-2977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-770-3709
Provider Business Mailing Address Fax Number:
201-770-3750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 KENNEDY BOULEVARD
Provider Second Line Business Practice Location Address:
ECECUTIVE OFFICE
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07305-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-770-3709
Provider Business Practice Location Address Fax Number:
201-770-3750
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
201-521-5920

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  10903 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 310105 . This is a "HORIZON BLUE CROSS OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4140702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: HU0000045-02 . This is a "AMERICHOICE MHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 310105 . This is a "ANTHEM GROUP NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 99751 . This is a "AMERIGROUP AMERICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: H05252 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1012309 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1015734 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0013075 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0004311000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J31132 . This is a "HEALTH NET PHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1015735 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1015736 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4140702 . This is a "CHARITY CARE UNYSIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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