Provider Demographics
NPI:1285635839
Name:GORRIN'S CLINIC, INC.
Entity Type:Organization
Organization Name:GORRIN'S CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANAPLASTOLOGIST/OCULARIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:O
Authorized Official - Last Name:GORRIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCCA
Authorized Official - Phone:864-233-2270
Mailing Address - Street 1:11 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-1629
Mailing Address - Country:US
Mailing Address - Phone:864-233-2270
Mailing Address - Fax:864-235-4327
Practice Address - Street 1:11 E PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1629
Practice Address - Country:US
Practice Address - Phone:864-233-2270
Practice Address - Fax:864-235-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC557524Medicaid
SC0201630001Medicare NSC