Provider Demographics
NPI:1194811547
Name:GREENVILLE PEDIATRIC ASSOCIATES, LTD
Entity type:Organization
Organization Name:GREENVILLE PEDIATRIC ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-588-1400
Mailing Address - Street 1:2 GREENVILLE ORTHOPEDIC CTR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1210
Mailing Address - Country:US
Mailing Address - Phone:724-588-1400
Mailing Address - Fax:724-588-1436
Practice Address - Street 1:2 GREENVILLE ORTHOPEDIC CTR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1210
Practice Address - Country:US
Practice Address - Phone:724-588-1400
Practice Address - Fax:724-588-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003941L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010267450003Medicaid
PAC31013Medicare UPIN