=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023438173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENVILLE HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2014
-----------------------------------------------------
Last Update Date | 01/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 877 W FARIS RD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29605-4289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-455-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 INDEPENDENCE PT SUITE 212
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615-4545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-797-6400
-----------------------------------------------------
Fax | 864-797-6198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MICHAEL C. RIORDAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-455-7978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | HTL343
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------