Provider Demographics
NPI:1164512380
Name:DOUGLAS E FLEMING LLC
Entity Type:Organization
Organization Name:DOUGLAS E FLEMING LLC
Other - Org Name:GREENVILLE SPORTS MEDICINE & REHAB, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ERROL
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-332-4950
Mailing Address - Street 1:1020 MARGARET BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-6453
Mailing Address - Country:US
Mailing Address - Phone:662-332-4950
Mailing Address - Fax:662-332-4956
Practice Address - Street 1:1020 MARGARET BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703
Practice Address - Country:US
Practice Address - Phone:662-332-4950
Practice Address - Fax:662-332-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS650000285Medicare ID - Type Unspecified