| |
10 Parkway South Greenville SC 29615 | |
(864) 458-6933 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 10 Parkway South, Greenville, South Carolina |
Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Brentwood TN 37027-4948 Ph: (888) 830-4255 | 10 Parkway South Greenville SC 29615 Ph: (864) 458-6933 |
NPI Number | 1588972426 |
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Provider Enumeration Date | 09/14/2010 |
Last Update Date | 08/23/2022 |
Medicare PECOS PAC ID | 2466620034 |
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Medicare Enrollment ID | O20110726000548 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588972426 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Douglas A Wix |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1073618047 PECOS PAC ID: 7416909338 Enrollment ID: I20050218000183 |
Provider Name | Amanda Hooper Seymour |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760603393 PECOS PAC ID: 1658470034 Enrollment ID: I20070627000357 |
Provider Name | Mark A Kemble |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457389637 PECOS PAC ID: 4486734787 Enrollment ID: I20071227000373 |
Provider Name | Gretchen Heidt Johnson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1427084367 PECOS PAC ID: 2860574902 Enrollment ID: I20080129000478 |
Provider Name | Corey L Hunt |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1730340464 PECOS PAC ID: 4183798812 Enrollment ID: I20080729000789 |
Provider Name | Robin A Grimm |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447459797 PECOS PAC ID: 1153473608 Enrollment ID: I20090715000229 |
Provider Name | Kenneth H Hommel |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1265402697 PECOS PAC ID: 6608929971 Enrollment ID: I20090804000364 |
Provider Name | Darly M Bernardo |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760481055 PECOS PAC ID: 5193757821 Enrollment ID: I20100408000234 |
Provider Name | Michael E Reed |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457310690 PECOS PAC ID: 9234043258 Enrollment ID: I20100625000879 |
Provider Name | Jennifer M Messervy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770804080 PECOS PAC ID: 3274729686 Enrollment ID: I20101124000927 |
Provider Name | Stephanie C Foster |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831493469 PECOS PAC ID: 1658554019 Enrollment ID: I20110322000636 |
Provider Name | Brandon Keith Hardee |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1902109093 PECOS PAC ID: 1254515653 Enrollment ID: I20110408000625 |
Provider Name | Annie Priscilla Carver Davis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578763991 PECOS PAC ID: 0648428128 Enrollment ID: I20120907000735 |
Provider Name | Elizabeth C Davenport-fox |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619225430 PECOS PAC ID: 6709029754 Enrollment ID: I20130823000823 |
Provider Name | Trisha M Roberts |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1780731471 PECOS PAC ID: 7719074194 Enrollment ID: I20140312001770 |
Provider Name | Robert M Smith |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548263734 PECOS PAC ID: 9335034479 Enrollment ID: I20150113001289 |
Provider Name | Jeremie M Kenney |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174801088 PECOS PAC ID: 4284895194 Enrollment ID: I20150116000624 |
Provider Name | Jason W Neufeld |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1962722181 PECOS PAC ID: 2668504648 Enrollment ID: I20150323000616 |
Provider Name | Ralph Daren Marionneaux |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215946140 PECOS PAC ID: 8628027703 Enrollment ID: I20170619001775 |
Provider Name | Julie Gibbons |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811287279 PECOS PAC ID: 0941470520 Enrollment ID: I20190828002976 |
Provider Name | Tram M Pham |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1033648183 PECOS PAC ID: 7911331194 Enrollment ID: I20191220001225 |
Provider Name | Marisa A Feliciano |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1437178340 PECOS PAC ID: 5890799688 Enrollment ID: I20200224001143 |
Provider Name | Cortney Shantres Ellis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396380283 PECOS PAC ID: 3870904162 Enrollment ID: I20201117001721 |
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