NPIMap

Organization Active NPI

Greenwood Genetic Center Lab

  • Clinical Medical Laboratory
  • Greenwood, SC
National Provider Identifier
1669463014
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
GREENWOOD GENETIC CENTER LAB
Practice address
106 Gregor Mendel Cir
Greenwood, SC 29646-2315
Phone
(864) 941-8100
Fax
(864) 941-8114
NPI assigned
Nov 3, 2005
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Pridmore
Title
Coo
Phone
(864) 941-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

106 Gregor Mendel Cir
Greenwood, SC 29646-2315

Mailing address

101 Gregor Mendel Cir
Greenwood, SC 29646-2316
Phone (864) 941-8100

Other identifiers 1

IdentifierTypeStateIssuer
480223MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060706000096 SC Part B Supplier - Independent Clinical Laboratory 9830097039 Practice locations: Greenwood, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0689473Greenwood Genetic Center106 Gregor Mendel Circle, Greenwood, SC 29646AccreditationAug 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Greenwood Genetic Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

101 S Ravenel St
Florence, SC 29506
Phone (843) 664-2983

101 S Ravenel St
Ste 370
Florence, SC 29506
Phone (877) 679-0927

14 Edgewood Dr
Greenville, SC 29605
Phone (864) 232-1803

1 Gregor Mendel Cir
Greenwood, SC 29646
Phone (864) 223-9311

125 Gregor Mendel Cir
Greenwood, SC 29646
Phone (864) 941-8100

3520 W Montague Ave
Ste 104
North Charleston, SC 29418
Phone (843) 746-1001

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1669463014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 GREGOR MENDEL CIR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462316",
            "telephone_number": "864-941-8100",
            "fax_number": "864-941-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 GREGOR MENDEL CIR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462315",
            "telephone_number": "864-941-8100",
            "fax_number": "864-941-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWOOD GENETIC CENTER LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "PRIDMORE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "864-941-8100"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "480223",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.