Provider Demographics
NPI:1982657953
Name:GREENVILLE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GREENVILLE HEALTH SYSTEM
Other - Org Name:GHS NORTH GREENVILLE LTACH
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:864-797-7808
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6308
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:807 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1551
Practice Address - Country:US
Practice Address - Phone:864-834-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-853282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA00853Medicaid
SC42D0253285OtherCLIA (LAB)
SCSELECT HEALTHOther60030
SC400818Medicaid
SCAETNAOther6510510
SC6897581OtherCIGNA (INTERNAL NUMBER)
SCUNISONOther000000163782
SCB00853Medicaid
SCUNISONOther000000163782
SC=========OtherGREAT WEST
SC=========OtherMEDCOST
SC=========-006OtherBLUE CROSS BLUE SHIELD #
SC400818Medicaid
SCA00853Medicaid
SCSELECT HEALTHOther60030
SCB00853Medicaid
SC=========OtherCAROLINA CARE PLAN