MEDICARE: THE GREENVILLE CLINIC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207U00000X	Nuclear Medicine Physician
2	2471B0102X	Bone Densitometry Radiologic Technologist
3	2471C3401X	Computed Tomography Radiologic Technologist
4	291U00000X	Clinical Medical Laboratory
5	246XC2903X	Vascular Specialist/Technologist Cardiovascular
6	2085R0202X	Diagnostic Radiology Physician
7	261QM1300X	Multi-Specialty Clinic/Center

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CD3504	OTHER	MS	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2500316731	OTHER	MS	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1003844978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GREENVILLE CLINIC

Provider Business Mailing Address
First Line	:	1502 S COLORADO ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7219
Country	:	US
Telephone Number	:	662-332-9872
Fax Number	:	662-332-9878

Provider Business Practice Location Address
First Line	:	1502 S COLORADO ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7219
Country	:	US
Telephone Number	:	662-332-9872
Fax Number	:	662-332-9878

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	REGINA E SPRATLIN
Credential	:
Telephone Number	:	662-379-8104

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	03/02/2026

1554 S COLORADO ST
GREENVILLE, MS
38703-7219

Practice Phone: 662-334-8557
Practice Fax: