Healthcare Provider Details

I. General information

NPI: 1891094470
Provider Name (Legal Business Name): ELIZABETH RUTH BAGSBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

IV. Provider business mailing address

2573 STANTONSBURG RD STE A
GREENVILLE NC
27834-7213
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-2140
  • Fax:
Mailing address:
  • Phone: 252-408-5400
  • Fax: 919-787-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01016522
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2018-02222
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2018-02222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: