Healthcare Provider Details

I. General information

NPI: 1790806651
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: 08/22/2020
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 TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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