MEDICARE: NORTHERN GREENBRIER HEALTH CLINIC, INC

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	511928	OTHER	WV	FQHC MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N051119281	OTHER	WV	PALMETTO GBA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	731098	OTHER	WV	CARELINK
5	51D0685085	OTHER	WV	CLIA

General Provider Information

NPI Number	:	1629283536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN GREENBRIER HEALTH CLINIC, INC

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	WILLIAMSBURG
State	:	WV
Zip	:	24991-0010
Country	:	US
Telephone Number	:	304-645-7872
Fax Number	:	304-645-7873

Provider Business Practice Location Address
First Line	:	RT 219 NORTH
Second Line	:
City	:	HILLSBORO
State	:	WV
Zip	:	24946-0470
Country	:	US
Telephone Number	:	304-653-4209
Fax Number	:	304-653-4233

Authorized Official
Title or Position	:	CEO
Name	:	GREG CURRY
Credential	:
Telephone Number	:	304-645-7872

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	03/31/2010

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Directions to “NORTHERN GREENBRIER HEALTH CLINIC, INC ” Practice Location

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