| Michelin Family Health Center | |
|
10 Parkway South Greenville SC 29615 | |
| (864) 458-6933 | |
| Not Available |
| Full Name | Michelin Family Health Center |
|---|---|
| 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 |
|---|---|
| Michelin Family Health Center 5500 Maryland Way Brentwood TN 37027-4948 Ph: (888) 830-4255 | Michelin Family Health Center 10 Parkway South Greenville SC 29615 Ph: (864) 458-6933 |
| NPI Number | 1588972426 |
|---|---|
| Provider Enumeration Date | 09/14/2010 |
| Last Update Date | 08/23/2022 |
| Medicare PECOS PAC ID | 2466620034 |
|---|---|
| Medicare Enrollment ID | O20110726000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588972426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 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 | 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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