Healthcare Provider Details

I. General information

NPI: 1295103620
Provider Name (Legal Business Name): GREENVILLE TRANSITIONS MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 RUTH VISTA RD
LEXINGTON SC
29073-8628
US

IV. Provider business mailing address

1575 HERITAGE DR SUITE 200
MCKINNEY TX
75069-3288
US

V. Phone/Fax

Practice location:
  • Phone: 803-714-3665
  • Fax:
Mailing address:
  • Phone: 844-633-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY PINCKNEY
Title or Position: VP OF PAYER RELATIONS
Credential:
Phone: 844-633-4663