Provider Demographics
NPI:1225352735
Name:GREENVILLE MEDICAL CARE
Entity Type:Organization
Organization Name:GREENVILLE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:252-757-0004
Mailing Address - Street 1:216 E ARLINGTON BLVD
Mailing Address - Street 2:P.O. BOX 8265
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5014
Mailing Address - Country:US
Mailing Address - Phone:252-757-0004
Mailing Address - Fax:252-757-0095
Practice Address - Street 1:216 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5014
Practice Address - Country:US
Practice Address - Phone:252-757-0004
Practice Address - Fax:252-757-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004089332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5004089OtherFNP
NC7000600Medicaid
NC7000600Medicaid
NCMM1843499OtherDEA