Provider Demographics
NPI:1245650381
Name:GREENVILLE HEALTH SYSTEM
Entity type:Organization
Organization Name:GREENVILLE HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:864-797-6400
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:20 MEDICAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4267
Practice Address - Country:US
Practice Address - Phone:864-220-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2015-10-01
Deactivation Date:2015-01-05
Deactivation Code:
Reactivation Date:2015-01-15
Provider Licenses
StateLicense IDTaxonomies
SCHTL343282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC354643Medicaid
SCCI4624OtherMEDICARE RAILROAD
SC400783Medicaid
SC42D0665869OtherCLIA
SCGP2859Medicaid
SC6510325OtherAETNA ID
SCCB9553OtherMEDICARE RAILROAD
SCCD7464OtherMEDICARE RAILROAD
SC111717Medicaid
SC354643Medicaid
SC420078Medicare Oscar/Certification