Basic Information
| Provider Information | |||||||||
| NPI: | 1982657953 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREENVILLE HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | GHS NORTH GREENVILLE LTACH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976308 | ||||||||
| FaxNumber: | 8647976198 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TRAVELERS REST | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296901551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648345132 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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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 | 282E00000X | HTL-853 | SC | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | A00853 | 05 | SC | MEDICAID | 42D0253285 | 01 | SC | CLIA (LAB) | OTHER | SELECT HEALTH | 01 | SC | 60030 | OTHER | 400818 | 05 | SC | MEDICAID | AETNA | 01 | SC | 6510510 | OTHER | 6897581 | 01 | SC | CIGNA (INTERNAL NUMBER) | OTHER | UNISON | 01 | SC | 000000163782 | OTHER | B00853 | 05 | SC | MEDICAID |