Provider Demographics
NPI:1124003496
Name:GREENVILLE HEALTH CORPORATION
Entity Type:Organization
Organization Name:GREENVILLE HEALTH CORPORATION
Other - Org Name:MOBILE CARE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PAYOR STRATEGIES & ALIGNMENT
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-2286
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0863
Mailing Address - Country:US
Mailing Address - Phone:800-948-7991
Mailing Address - Fax:
Practice Address - Street 1:1315 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4717
Practice Address - Country:US
Practice Address - Phone:864-220-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0098Medicaid
SC590007346OtherRAILROAD MEDICARE PROV NO
SCQ275850003Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER