Provider Demographics
NPI:1851341408
Name:GREENVILLE HEALTH CARE CENTER,PA
Entity Type:Organization
Organization Name:GREENVILLE HEALTH CARE CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-758-4455
Mailing Address - Street 1:3121 MOSELEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4245
Mailing Address - Country:US
Mailing Address - Phone:252-758-4455
Mailing Address - Fax:252-758-6742
Practice Address - Street 1:3121 MOSELEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4245
Practice Address - Country:US
Practice Address - Phone:252-758-4455
Practice Address - Fax:252-758-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBCBS OF NCOtherBCBS GROUP NUMBER
NC890170AMedicaid
NC890170AMedicaid