Organization
PROVIDENT EAR NOSE AND THROAT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM MICHAEL GREENE MD (OWNER)
(864) 284-9869
Entity
Organization
Contact information
Practice address
101 S VENTURE DR, GREENVILLE, SC 29615-3571
(864) 232-4846
(888) 451-9614
Mailing address
101 S VENTURE DR, GREENVILLE, SC 29615-3571
(864) 284-9869
(864) 284-9882
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
18523
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T25960
—
SC
Enumeration date
06/29/2009
Last updated
12/18/2014
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