Healthcare Provider Details

I. General information

NPI: 1780635326
Provider Name (Legal Business Name): GREENVILLE COLON & RECTAL ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BEAR DR
GREENVILLE SC
29605
US

IV. Provider business mailing address

PO BOX 8899
GREENVILLE SC
29604-8899
US

V. Phone/Fax

Practice location:
  • Phone: 864-269-5500
  • Fax: 864-269-8568
Mailing address:
  • Phone: 864-269-5500
  • Fax: 864-269-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number9908
License Number StateSC

VIII. Authorized Official

Name: JAMES A ROBBINS
Title or Position: PRESIDENT
Credential: MD
Phone: 864-269-5500