=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518950716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GREENWOOD ENDOSCOPY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2005
-----------------------------------------------------
Last Update Date | 03/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 LINER DR
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-227-3838
-----------------------------------------------------
Fax | 864-227-6116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 LINER DR
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-227-3838
-----------------------------------------------------
Fax | 864-227-6116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. APRIL CRISP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-227-3838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | ASF022
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------