Provider Demographics
NPI:1720034994
Name:GREER GROUP PRACTICE, LLC
Entity Type:Organization
Organization Name:GREER GROUP PRACTICE, LLC
Other - Org Name:MOUNTAINVIEW FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-560-4057
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:406 MEMORIAL DRIVE EXT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1818
Practice Address - Country:US
Practice Address - Phone:864-877-9066
Practice Address - Fax:864-848-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA6208OtherRAILROAD MEDICARE GROUP #
SCGP2793Medicaid
SCGP2793Medicaid
SC=========OtherTRICARE
SC6634Medicare PIN