Provider Demographics
NPI:1275884652
Name:GREENVILLE HEALTH CARE CENTER, P.A.
Entity Type:Organization
Organization Name:GREENVILLE HEALTH CARE CENTER, P.A.
Other - Org Name:BETHEL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:252-758-4455
Mailing Address - Street 1:7439 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-7201
Mailing Address - Country:US
Mailing Address - Phone:252-758-4455
Mailing Address - Fax:252-758-6742
Practice Address - Street 1:7439 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812-7201
Practice Address - Country:US
Practice Address - Phone:252-758-4455
Practice Address - Fax:252-758-6742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENVILLE HEALTH CARE CENTER, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-26
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty