Healthcare Provider Details

I. General information

NPI: 1124469143
Provider Name (Legal Business Name): GREENVILLE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 HIGHWAY 76 E
CLINTON SC
29325-7527
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-9100
  • Fax: 864-833-9297
Mailing address:
  • Phone: 864-797-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRI T. NEWSOM
Title or Position: VP FINANCIAL SERVICES AND CFO
Credential:
Phone: 864-455-8950