Provider Demographics
NPI:1619182482
Name:GREER PEDIATRIC CLINIC LLC
Entity Type:Organization
Organization Name:GREER PEDIATRIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-879-3883
Mailing Address - Street 1:554 MEMORIAL DRIVE EXT STE C
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1155
Mailing Address - Country:US
Mailing Address - Phone:864-879-3883
Mailing Address - Fax:864-848-3492
Practice Address - Street 1:554 MEMORIAL DRIVE EXT STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1155
Practice Address - Country:US
Practice Address - Phone:864-879-3883
Practice Address - Fax:864-848-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1829Medicaid