Provider Demographics
NPI:1326097924
Name:GREENVILLE GASTROENTEROLOGY, S.C.
Entity Type:Organization
Organization Name:GREENVILLE GASTROENTEROLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-664-9002
Mailing Address - Street 1:150 HEALTH CARE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1161
Mailing Address - Country:US
Mailing Address - Phone:618-664-9002
Mailing Address - Fax:618-664-9003
Practice Address - Street 1:150 HEALTH CARE DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1161
Practice Address - Country:US
Practice Address - Phone:618-664-9002
Practice Address - Fax:618-664-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty