Provider Demographics
NPI:1629283536
Name:NORTHERN GREENBRIER HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:NORTHERN GREENBRIER HEALTH CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-7872
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24991-0010
Mailing Address - Country:US
Mailing Address - Phone:304-645-7872
Mailing Address - Fax:304-645-7873
Practice Address - Street 1:RT 219 NORTH
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WV
Practice Address - Zip Code:24946-0470
Practice Address - Country:US
Practice Address - Phone:304-653-4209
Practice Address - Fax:304-653-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVN051119281OtherPALMETTO GBA
WV3810009778Medicaid
WV511928OtherFQHC MEDICARE
WV731098OtherCARELINK
WV51D0685085OtherCLIA