Provider Demographics
NPI:1467524082
Name:GREENBRIER VALLEY ENT PLLC
Entity Type:Organization
Organization Name:GREENBRIER VALLEY ENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-645-0870
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-0902
Mailing Address - Country:US
Mailing Address - Phone:304-520-4991
Mailing Address - Fax:
Practice Address - Street 1:118 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1337
Practice Address - Country:US
Practice Address - Phone:304-520-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1071033OtherBRICK STREET W/COMP
WV129458Medicaid
WV001916386OtherMTN ST BCBS
WV1306817689OtherUNISYS
611994100OtherFEDERAL BLACK LUNG
7786898OtherAETNA
7786898OtherAETNA
WV1306817689OtherUNISYS