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General NPI Number Information
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NPI Number | 1659654002
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Entity Type | Organization
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Legal Business Name | GREENVILLE KIDNEY CARE LLC
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 29 MEMORIAL MEDICAL DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4407
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Country | US
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Telephone | 864-220-1200
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Fax | 864-220-1888
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Provider Business Mailing Address
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Address Line | 29 MEMORIAL MEDICAL DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4407
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Country | US
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Telephone | 864-220-1200
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Fax | 864-220-1888
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | HANNAH COOLEY
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Credential |
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Telephone | 864-312-3105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 23113
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License Number State | SC
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