Healthcare Provider Details

I. General information

NPI: 1821555418
Provider Name (Legal Business Name): GREENBRIER SIGNATURE HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40823 MIDLAND TRL E
WHITE SULPHUR SPRINGS WV
24986-5064
US

IV. Provider business mailing address

40823 MIDLAND TRL E
WHITE SULPHUR SPRINGS WV
24986-5064
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-4870
  • Fax: 304-536-7857
Mailing address:
  • Phone: 304-536-4870
  • Fax: 304-536-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JILLIAN JUSTICE
Title or Position: PRESIDENT
Credential: DO
Phone: 304-536-4870