| Greenville Medical Associates, Pa | |
|
545 W Butler Rd Greenville SC 29607-4833 | |
| (864) 236-9555 | |
| (864) 236-9551 |
| Full Name | Greenville Medical Associates, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 545 W Butler Rd, Greenville, South Carolina |
| Authorized Official Name and Position | Naveen Reddy Bethi (PRESIDENT) |
| Authorized Official Contact | 8649015876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenville Medical Associates, Pa 545 W Butler Rd Greenville SC 29607-4833 Ph: (864) 236-9555 | Greenville Medical Associates, Pa 545 W Butler Rd Greenville SC 29607-4833 Ph: (864) 236-9555 |
| NPI Number | 1316251101 |
|---|---|
| Provider Enumeration Date | 08/04/2010 |
| Last Update Date | 08/07/2019 |
| Medicare PECOS PAC ID | 2567642440 |
|---|---|
| Medicare Enrollment ID | O20110209000895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316251101 | NPI | - | NPPES |
| T55491 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 21344 (South Carolina) | Primary |
| Provider Name | Naveen R Bethi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952330011 PECOS PAC ID: 6608771746 Enrollment ID: I20031203000204 |
| Provider Name | Trishia Lynn Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225775380 PECOS PAC ID: 6305216870 Enrollment ID: I20221227000482 |
| Provider Name | Julian David Areiza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821723107 PECOS PAC ID: 1153791033 Enrollment ID: I20230111000445 |
| Provider Name | Taylor Ashton Hamby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013795822 PECOS PAC ID: 8426405697 Enrollment ID: I20231109000459 |
| Provider Name | Lacey Marie Wilbanks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023893922 PECOS PAC ID: 8224480652 Enrollment ID: I20240122000729 |
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