Organization
GREENBRIER VMC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
RR 2 BOX 171-C, GREYROCK PROFESSIONAL PARK, LEWISBURG, WV 24901-9318
(304) 793-2059
Mailing address
PO BOX 533, RONCEVERTE, WV 24970-0533
(304) 793-2059
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106041003
—
WV
Enumeration date
06/21/2007
Last updated
12/06/2007
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