Healthcare Provider Details

I. General information

NPI: 1316910086
Provider Name (Legal Business Name): GREENVILLE ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HAWTHORNE PARK CT
GREENVILLE SC
29615-3194
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN: L&C
NASHVILLE TN
37215-6103
US

V. Phone/Fax

Practice location:
  • Phone: 864-331-0364
  • Fax: 864-331-0370
Mailing address:
  • Phone: 864-331-0364
  • Fax: 864-331-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF086
License Number StateSC

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283