Provider Demographics
NPI:1225453269
Name:GREENVILLE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GREENVILLE HEALTH SYSTEM
Other - Org Name:GHS PATEWOOD OP CENTER BLDG A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-455-7978
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6307
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:BUILDING A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2015-01-15
Deactivation Date:2015-01-05
Deactivation Code:
Reactivation Date:2015-01-15
Provider Licenses
StateLicense IDTaxonomies
SCHTL-0900282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8724OtherMEDICARE B
SC197266OtherMEDCOST
SC7956918OtherAETNA
SC---------------194OtherBLUE CHOICE
SC6055895OtherCIGNA
SC400293Medicaid
SC--------------194OtherBCBS
SC-------------194OtherCHAMPUS / TRICARE
SC323510OtherMULTIPLAN
SC420102OtherMEDICARE A
SC7981966170001OtherGREAT WEST