Provider Demographics
NPI:1932203122
Name:NORTHERN GREENBRIER HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:NORTHERN GREENBRIER HEALTH CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-7872
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24991-0010
Mailing Address - Country:US
Mailing Address - Phone:304-645-7872
Mailing Address - Fax:304-645-7873
Practice Address - Street 1:RT 9 SINKING CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:WV
Practice Address - Zip Code:24991-0010
Practice Address - Country:US
Practice Address - Phone:304-645-7872
Practice Address - Fax:304-645-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035057000Medicaid
WV205018OtherCARELINK
WVN09253271OtherPALMETTO GBA
WV51D0233805OtherCLIA
WV001709718OtherBC/BS
WV0035057000Medicaid
WV511802Medicare ID - Type Unspecified