MEDICARE: GREENBRIER VMC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0000X	Cardiovascular Disease Physician
2	207R00000X	Internal Medicine Physician
3	208600000X	Surgery Physician

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

General Provider Information

NPI Number	:	1417153172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIER VMC LLC

Provider Business Mailing Address
First Line	:	PO BOX 533
Second Line	:
City	:	RONCEVERTE
State	:	WV
Zip	:	24970-0533
Country	:	US
Telephone Number	:	304-793-2059
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 2 BOX 171-C
Second Line	:	GREYROCK PROFESSIONAL PARK
City	:	LEWISBURG
State	:	WV
Zip	:	24901-9318
Country	:	US
Telephone Number	:	304-793-2059
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	877-892-9813

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	12/06/2007

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Directions to “GREENBRIER VMC LLC ” Practice Location

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