Provider Demographics
NPI:1740609908
Name:GREENVILLE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GREENVILLE HEALTH SYSTEM
Other - Org Name:GHS CANCER INST-FARIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-455-7978
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6306
Mailing Address - Fax:
Practice Address - Street 1:900 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4255
Practice Address - Country:US
Practice Address - Phone:864-679-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2015-01-15
Deactivation Date:2015-01-05
Deactivation Code:
Reactivation Date:2015-01-15
Provider Licenses
StateLicense IDTaxonomies
SCHTL-343282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2859Medicaid
SCCI4624OtherMEDICARE RAILROAD
SC111717Medicaid
SC6510325OtherAETNA
SC400783Medicaid
SCCB9553OtherMEDICARE RAILROAD
SC354643Medicaid
SCCD7464OtherMEDICARE RAILROAD
SC42D0665869OtherCLIA
SCCB9553OtherMEDICARE RAILROAD
SC400783Medicaid