MEDICARE: GREENVILLE HEALTH CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4222434	OTHER	SC	NABP NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	018	OTHER	SC	BCBS SUFFIX

General Provider Information

NPI Number	:	1265417927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-455-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PATEWOOD DR
Second Line	:	SUITE B-150
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3593
Country	:	US
Telephone Number	:	864-454-2369
Fax Number	:

Authorized Official
Title or Position	:	VP PAYOR STATEGIES & ALIGNMENT
Name	:	POLLY H. MILLER
Credential	:
Telephone Number	:	864-522-2286

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	03/07/2023

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Directions to “GREENVILLE HEALTH CORPORATION ” Practice Location

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