Provider Demographics
NPI:1447463179
Name:GREENWOOD FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:GREENWOOD FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-223-6621
Mailing Address - Street 1:1226 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3835
Mailing Address - Country:US
Mailing Address - Phone:864-223-6621
Mailing Address - Fax:864-223-6659
Practice Address - Street 1:1226 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3835
Practice Address - Country:US
Practice Address - Phone:864-223-6621
Practice Address - Fax:864-223-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23953332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1417972548OtherNPI
SC236953OtherSC LICENSE#
SC4226824OtherNCPDP#
SC1184844458OtherPHARMACY NPI#
SC7DP004Medicaid
SC7DP004Medicaid
SCH84948Medicare UPIN