=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487213724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER GREENWOOD UNITED MINISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1404 EDGEFIELD STREET
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-942-0500
-----------------------------------------------------
Fax | 864-229-0332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1404 EDGEFIELD STREET
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-942-0500
-----------------------------------------------------
Fax | 864-229-0332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. ROSEMARY CANNON BELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-980-8895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------