Healthcare Provider Details

I. General information

NPI: 1043258783
Provider Name (Legal Business Name): GREENBRIER CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WEST MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2414
US

IV. Provider business mailing address

320 WEST MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2414
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-4870
  • Fax: 304-536-8010
Mailing address:
  • Phone: 304-536-4870
  • Fax: 304-536-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: N ED JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 304-536-4870