Provider Demographics
NPI:1851344436
Name:GREENVILLE PATHOLOGY, PA
Entity Type:Organization
Organization Name:GREENVILLE PATHOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:AINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-561-7992
Mailing Address - Street 1:2515 BOWMAN GRAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7215
Mailing Address - Country:US
Mailing Address - Phone:252-561-7992
Mailing Address - Fax:252-752-2016
Practice Address - Street 1:2515 BOWMAN GRAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7215
Practice Address - Country:US
Practice Address - Phone:252-561-7992
Practice Address - Fax:252-752-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D0872845291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0255UOtherBCBS
NCCH2834OtherMEDICARE RR
NC10301964OtherVOCATIONAL REHAB
NC34D0872845OtherCLIA
NC790255UMedicaid
NC10301964OtherVOCATIONAL REHAB