Healthcare Provider Details

I. General information

NPI: 1154442028
Provider Name (Legal Business Name): GREENBRIER PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAPLEWOOD AVE
RONCEVERTE WV
24970-1334
US

IV. Provider business mailing address

200 MAPLEWOOD AVE
RONCEVERTE WV
24970-1334
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-1140
  • Fax: 304-647-3006
Mailing address:
  • Phone: 304-647-1140
  • Fax: 304-647-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code2472D0500X
TaxonomyDarkroom Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN D TROUT
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 304-647-1140