Provider Demographics
NPI:1265867121
Name:GREENVILLE NEUROMODULATION CENTER, INC.
Entity Type:Organization
Organization Name:GREENVILLE NEUROMODULATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BOD
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-588-1324
Mailing Address - Street 1:179 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2145
Mailing Address - Country:US
Mailing Address - Phone:724-588-1324
Mailing Address - Fax:
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2145
Practice Address - Country:US
Practice Address - Phone:724-588-1324
Practice Address - Fax:724-373-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA598817283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital