Healthcare Provider Details

I. General information

NPI: 1568401461
Provider Name (Legal Business Name): GREENBRIER EMERGENCY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOYLMAN DR
GASSAWAY WV
26624-9320
US

IV. Provider business mailing address

PO BOX 634715
CINCINNATI OH
45263-4715
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-5156
  • Fax:
Mailing address:
  • Phone: 888-203-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDAL L. DABBS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-693-1000