Provider Demographics
NPI:1033477187
Name:GREENEVILLE PHYSICIAN SERVICES, L.L.C.
Entity Type:Organization
Organization Name:GREENEVILLE PHYSICIAN SERVICES, L.L.C.
Other - Org Name:LAUGHLIN MEDICAL GROUP, PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-915-5116
Mailing Address - Street 1:1406 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4332
Mailing Address - Country:US
Mailing Address - Phone:423-783-5520
Mailing Address - Fax:423-783-5521
Practice Address - Street 1:1406 TUSCULUM BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4332
Practice Address - Country:US
Practice Address - Phone:423-783-5520
Practice Address - Fax:423-783-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty