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General NPI Number Information
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NPI Number | 1184213951
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Entity Type | Organization
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Legal Business Name | QUALITY CARE PHYSICIANS GREENVILLE PLLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 8090 MONTY STRATTON BLVD
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City | GREENVILLE
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State | TX
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Zip | 75402
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Country | US
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Telephone | 903-609-4125
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 CASCADES SHORELINE DR
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City | TYLER
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State | TX
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Zip | 75709-8900
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Country | US
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Telephone | 903-372-4326
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. COLIN MARINO
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Credential | MD
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Telephone | 903-372-4326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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