=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851341408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENVILLE HEALTH CARE CENTER,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3121 MOSELEY DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-4245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-758-4455
-----------------------------------------------------
Fax | 252-758-6742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3121 MOSELEY DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-4245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-758-4455
-----------------------------------------------------
Fax | 252-758-6742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. DONALD A RIBEIRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 252-758-4455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 31627
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------