# PROVIDENT EAR NOSE AND THROAT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922236074
- **Authorized official:** MR. WILLIAM MICHAEL GREENE MD (OWNER)
- **Authorized official phone:** (864) 284-9869

## Contact information

- **Practice address:** 101 S VENTURE DR, GREENVILLE, SC 29615-3571
- **Practice address phone:** (864) 232-4846
- **Practice address fax:** (888) 451-9614
- **Mailing address:** 101 S VENTURE DR, GREENVILLE, SC 29615-3571
- **Mailing address phone:** (864) 284-9869
- **Mailing address fax:** (864) 284-9882

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | 18523 | SC | Yes |

## Other

- **Enumeration date:** 06/29/2009
- **Last updated:** 12/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | T25960 | — | SC |