Provider Demographics
NPI:1477717312
Name:GREENVILLE EXPRESS CARE, PA
Entity Type:Organization
Organization Name:GREENVILLE EXPRESS CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-413-0720
Mailing Address - Street 1:PO BOX 30965
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0965
Mailing Address - Country:US
Mailing Address - Phone:252-413-0720
Mailing Address - Fax:
Practice Address - Street 1:615 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2856
Practice Address - Country:US
Practice Address - Phone:252-413-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0170AOtherBCBS OF NC
NC8971512Medicaid
NC2326087Medicare PIN