Provider Demographics
NPI:1780742502
Name:THE OBGYN GROUP OF GREENVILLE
Entity type:Organization
Organization Name:THE OBGYN GROUP OF GREENVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-297-0616
Mailing Address - Street 1:135 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4831
Mailing Address - Country:US
Mailing Address - Phone:864-297-0616
Mailing Address - Fax:864-297-4248
Practice Address - Street 1:135 COMMONWEALTH DR
Practice Address - Street 2:SUITE 210
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4831
Practice Address - Country:US
Practice Address - Phone:864-297-0616
Practice Address - Fax:864-297-4248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1295769438
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157Medicare PIN