Healthcare Provider Details

I. General information

NPI: 1124003496
Provider Name (Legal Business Name): GREENVILLE HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 GROVE RD
GREENVILLE SC
29605-4717
US

IV. Provider business mailing address

PO BOX 863
LEWISVILLE NC
27023-0863
US

V. Phone/Fax

Practice location:
  • Phone: 864-220-9311
  • Fax:
Mailing address:
  • Phone: 800-948-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number216
License Number StateSC

VIII. Authorized Official

Name: POLLY H. MILLER
Title or Position: VP PAYOR STRATEGIES & ALIGNMENT
Credential:
Phone: 864-522-2286