Healthcare Provider Details

I. General information

NPI: 1548440407
Provider Name (Legal Business Name): GREENVILLE SURGICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W H SMITH BLVD SUITE 100
GREENVILLE NC
27834-3787
US

IV. Provider business mailing address

1011 W H SMITH BLVD SUITE 100
GREENVILLE NC
27834-3787
US

V. Phone/Fax

Practice location:
  • Phone: 252-754-8370
  • Fax: 252-754-8387
Mailing address:
  • Phone: 252-754-8370
  • Fax: 252-754-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number9800894
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9800894
License Number StateNC

VIII. Authorized Official

Name: BARRY RUSSELL HASTINGS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 252-754-8370