Provider Demographics
NPI:1679542971
Name:GREENVILLE PEDIATRIC SERVICES, INC
Entity Type:Organization
Organization Name:GREENVILLE PEDIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-7141
Mailing Address - Street 1:300 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7218
Mailing Address - Country:US
Mailing Address - Phone:252-752-7141
Mailing Address - Fax:252-752-0223
Practice Address - Street 1:300 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7218
Practice Address - Country:US
Practice Address - Phone:252-752-7141
Practice Address - Fax:252-752-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01682OtherBLUE CROSS BLUE SHIELD OF
NC8901682Medicaid