=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023029188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARTNERS IN HEALTH - RURAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 03/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9100 HIGHWAY 14
-----------------------------------------------------
City | GRAY COURT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29645-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-876-4888
-----------------------------------------------------
Fax | 864-876-4900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 INDEPENDENCE PT SUITE 212
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615-4545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-797-6044
-----------------------------------------------------
Fax | 864-797-6198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. MICHAEL C RIORDAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-455-7978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------