NPIMap

Organization Active NPI

Pediatric Rural Health Clinics, Inc

Doing business as Greenville Pediatrics

  • Pediatric Nurse Practitioner
  • Greenville, AL
National Provider Identifier
1992742860
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
1-065300 Issued in AL
Legal business name
PEDIATRIC RURAL HEALTH CLINICS, INC
Doing business as
Greenville Pediatrics
Practice address
46 L V Stabler Dr
Greenville, AL 36037-3804
Phone
(334) 382-9760
Fax
(334) 383-9331
NPI assigned
Jun 1, 2006
Last updated
Oct 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

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

Authorized official

Name
Mrs. Anne Keen, CRNPNPI 1609915974
Title
VP of Operations
Phone
(334) 382-9760

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 00006213 AL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 00024891 AL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 00006634 AL
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X 1-065300 AL Primary
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X 01-069655 AL

Addresses

Primary practice location

46 L V Stabler Dr
Greenville, AL 36037-3804

Mailing address

46 L V Stabler Dr
Greenville, AL 36037-3804
Phone (334) 382-9760

Other names 1

  • GREENVILLE PEDIATRICS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060328000167 AL Part A Provider - Rural Health Clinic 0042228496 Practice locations: Greenville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992742860. Details of each certification follow.

Rural health clinic certification: CCN 013905

Legal name
PEDIATRIC RURAL HEALTH CLINICS, INC
Doing business as
GREENVILLE PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 16, 1998
Last certification
Jul 3, 2025
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Nov 25, 1997 in AL
Enrollment address
46 L.V. Stabler Dr.
Greenville, AL 36037-3865

National Provider Directory

National Provider Directory

Locations

46 L V Stabler Dr
Greenville, AL 36037
Phone (334) 382-9760

84 L V Stabler Dr
Greenville, AL 36037
Phone (334) 371-3232

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anne Keen Individual 5% Or Greater Direct Ownership Interest Nov 25, 1997 25%
W-2 Managing EmployeeVP of Operations Nov 25, 1997 25%
John Sumners Individual 5% Or Greater Direct Ownership Interest Nov 25, 1997 37.5%
Corporate OfficerPresident Nov 25, 1997 37.5%
William Sumners Individual 5% Or Greater Direct Ownership Interest Nov 25, 1997 37.5%
Corporate OfficerVice President Nov 25, 1997 37.5%

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1992742860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 L V STABLER DR",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360373804",
            "telephone_number": "334-382-9760",
            "fax_number": "334-383-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 L V STABLER DR",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360373804",
            "telephone_number": "334-382-9760",
            "fax_number": "334-383-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC RURAL HEALTH CLINICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "KEEN",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "334-382-9760",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "00006213",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "00024891",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "00006634",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "1-065300",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "01-069655",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREENVILLE PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, AL

Sources for this page

Verify at the official NPI Registry.