Provider Demographics
NPI:1811936008
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:864-797-6307
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:875 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4254
Practice Address - Country:US
Practice Address - Phone:864-455-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPE050Medicaid
SCAETNAOther5334522
SC5334522OtherBLUE CROSS
SC20026599OtherSELECT HEALTH IND ID
SC=========OtherUNISON
SCDPE050Medicaid
SCDPE050Medicaid