Provider Demographics
NPI:1164858551
Name:GREENVILLE HEALTH CORPORATION
Entity Type:Organization
Organization Name:GREENVILLE HEALTH CORPORATION
Other - Org Name:PRISMA HEALTH CENTER FOR PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE, ENTERPRISE CONTRACTING
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-455-7000
Mailing Address - Fax:
Practice Address - Street 1:10702A CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4528
Practice Address - Country:US
Practice Address - Phone:864-885-0077
Practice Address - Fax:864-885-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0306710004OtherMEDICARE PTAN
SCDE3512Medicaid