Provider Demographics
NPI:1629266432
Name:GREENBRIER CARE LLC
Entity Type:Organization
Organization Name:GREENBRIER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-536-4870
Mailing Address - Street 1:167 KATES MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2414
Mailing Address - Country:US
Mailing Address - Phone:304-536-4870
Mailing Address - Fax:304-536-8010
Practice Address - Street 1:167 KATES MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-2414
Practice Address - Country:US
Practice Address - Phone:304-536-4870
Practice Address - Fax:304-536-8010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENBRIER CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDG9945OtherRAILROAD PTAN
VA345877OtherANTHEM
WV02007626OtherBLUECROSS/BLUESHIELD
WV02007626OtherBLUECROSS/BLUESHIELD