Basic Information
| Provider Information | |||||||||
| NPI: | 1184049041 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREENVILLE HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | GHS VASCULAR HEALTH ALLIANCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976307 | ||||||||
| FaxNumber: | 8647976198 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PATEWOOD DR | ||||||||
| Address2: | SUITE C 300 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296153593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644548272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2014 | ||||||||
| LastUpdateDate: | 04/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | RIORDAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 8647977808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | HTL-0900 | SC | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 323510 | 01 | SC | MULTIPLAN | OTHER | 6055895 | 01 | SC | CIGNA | OTHER | 7956918 | 01 | SC | AETNA | OTHER | ---------194 | 01 | SC | CHAMPUS / TRICARE | OTHER | 197266 | 01 | SC | MEDCOST | OTHER | 400293 | 05 | SC | MEDICAID | --------194 | 01 | SC | BLUE CHOICE | OTHER | 420102 | 01 | SC | MEDICARE A | OTHER | 7981966170001 | 01 | SC | GREAT WEST | OTHER | 8724 | 01 | SC | MEDICARE B | OTHER | --------194 | 01 | SC | BLUE CROSS | OTHER |