Provider Demographics
NPI:1851324271
Name:GREENVILLE FOOTCARE LLC
Entity Type:Organization
Organization Name:GREENVILLE FOOTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-745-0211
Mailing Address - Street 1:220 FORT DALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-1502
Mailing Address - Country:US
Mailing Address - Phone:334-382-1400
Mailing Address - Fax:
Practice Address - Street 1:220 FORT DALE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-1502
Practice Address - Country:US
Practice Address - Phone:334-382-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherGROUP TAX ID NUMBER
AL=========OtherGROUP TAX ID NUMBER