Provider Demographics
NPI:1215388327
Name:GREENWOOD MEDICAL REHABILITATION
Entity Type:Organization
Organization Name:GREENWOOD MEDICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THIRSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:910-495-6287
Mailing Address - Street 1:PO BOX 31166
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-0020
Mailing Address - Country:US
Mailing Address - Phone:910-495-6287
Mailing Address - Fax:910-222-3063
Practice Address - Street 1:100 WATER GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8162
Practice Address - Country:US
Practice Address - Phone:843-366-4000
Practice Address - Fax:910-222-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16859Medicare UPIN