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General NPI Number Information
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NPI Number | 1447581434
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Entity Type | Organization
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Legal Business Name | GREENBRIER VMC, LLC
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 202 MAPLEWOOD AVE
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City | RONCEVERTE
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State | WV
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Zip | 24970-1334
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Country | US
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Telephone | 304-347-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 13662 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0136
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Country | US
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Telephone | 304-347-4411
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAURIE HOLTSFORD
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Credential |
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Telephone | 615-465-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 55
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License Number State | WV
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