MEDICARE: GREENVILLE HEALTH SYSTEM

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	251300000X	Local Education Agency (LEA)

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	AETNA	OTHER	SC	5334522
3	5334522	OTHER	SC	BLUE CROSS
4	20026599	OTHER	SC	SELECT HEALTH IND ID

General Provider Information

NPI Number	:	1811936008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4545
Country	:	US
Telephone Number	:	864-797-6307
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	875 W FARIS RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4254
Country	:	US
Telephone Number	:	864-455-4003
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MICHAEL C RIORDAN
Credential	:
Telephone Number	:	864-797-7808

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/18/2016

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Directions to “GREENVILLE HEALTH SYSTEM ” Practice Location

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