Provider Demographics
NPI:1407949100
Name:GREENEVILLE ORTHOPAEDIC CLINIC, P.C.
Entity Type:Organization
Organization Name:GREENEVILLE ORTHOPAEDIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PECTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-639-2103
Mailing Address - Street 1:223 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745
Mailing Address - Country:US
Mailing Address - Phone:423-639-2103
Mailing Address - Fax:423-639-1642
Practice Address - Street 1:223 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745
Practice Address - Country:US
Practice Address - Phone:423-639-2103
Practice Address - Fax:423-639-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0744300001Medicare NSC
TN3375561Medicare ID - Type Unspecified