Organization
GREENVILLE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THORA R JACKSON (ADMINISTRATOR)
(724) 589-4300
Entity
Organization
Contact information
Practice address
90 SHENANGO ST, GREENVILLE, PA 16125-2060
(724) 588-4240
(724) 588-0198
Mailing address
90 SHENANGO ST, GREENVILLE, PA 16125-2060
(724) 588-4240
(724) 588-0198
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085B0100X
Body Imaging Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006509810001
—
PA
Enumeration date
03/14/2006
Last updated
09/11/2025
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