Healthcare Provider Details

I. General information

NPI: 1073146502
Provider Name (Legal Business Name): GREENVILLE HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N SUMTER ST STE 220
SUMTER SC
29150-4972
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-8772
  • Fax: 864-455-8247
Mailing address:
  • Phone: 864-797-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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