Healthcare Provider Details

I. General information

NPI: 1679542971
Provider Name (Legal Business Name): GREENVILLE PEDIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BETHESDA DR
GREENVILLE NC
27834-7218
US

IV. Provider business mailing address

300 BETHESDA DR
GREENVILLE NC
27834-7218
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-7141
  • Fax: 252-752-0223
Mailing address:
  • Phone: 252-752-7141
  • Fax: 252-752-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCES MEADOWS
Title or Position: MANAGER
Credential:
Phone: 252-752-7141