Healthcare Provider Details

I. General information

NPI: 1710931100
Provider Name (Legal Business Name): RALPH EMERSON GREENE III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 S BARRINGTON DR
FLORENCE SC
29501-8668
US

IV. Provider business mailing address

587 BAIRD COVE RD
FRANKLIN NC
28734-1999
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-3781
  • Fax: 843-669-1995
Mailing address:
  • Phone: 828-369-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN351
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: