NPIMap

Organization Active NPI

Greenville Ear Nose & Throat

  • Oral and Maxillofacial Surgery Clinic/Center
  • Greenville, SC
National Provider Identifier
1932169273
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
15939 Issued in SC
Legal business name
GREENVILLE EAR NOSE & THROAT
Practice address
200 Patewood Dr
Building B Suite B400
Greenville, SC 29615-3593
Phone
(864) 454-4368
Fax
(864) 454-4345
NPI assigned
Mar 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Authorized official

Name
Dr. John Gordon Phillips, M.D.NPI 1790731412
Title
Dr. John Gordon Phillips
Phone
(864) 454-4368

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 15939 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Building B Suite B400
Greenville, SC 29615-3593

Mailing address

PO Box 26569
Greenville, SC 29616-1569
Phone (864) 454-4368

Other identifiers 2

IdentifierTypeStateIssuer
CL5602OtherSCRAILROAD MEDICARE
GP0618MedicaidSC

National Provider Directory

National Provider Directory

Locations

890 W Faris Rd
Ste 570
Greenville, SC 29605
Phone (803) 232-0883

200 Patewood Dr
Ste B400
Greenville, SC 29615
Phone (864) 454-4368

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1932169273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26569",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296161569",
            "telephone_number": "864-454-4368",
            "fax_number": "864-454-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "BUILDING B SUITE B400",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-4368",
            "fax_number": "864-454-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE EAR NOSE & THROAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "DR. JOHN GORDON PHILLIPS",
        "authorized_official_telephone_number": "864-454-4368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "15939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL5602",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0618",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.