Provider Demographics
NPI:1194153379
Name:GREENBRIER CENTER FOR COMPREHENSIVE OTOLARYNGOLOGY, PLLC
Entity type:Organization
Organization Name:GREENBRIER CENTER FOR COMPREHENSIVE OTOLARYNGOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-645-0870
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4470
Mailing Address - Country:US
Mailing Address - Phone:304-520-4991
Mailing Address - Fax:304-520-4994
Practice Address - Street 1:231 DAWKINS DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9674
Practice Address - Country:US
Practice Address - Phone:304-520-4991
Practice Address - Fax:304-520-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty