Basic Information
| Provider Information | |||||||||
| NPI: | 1194191536 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREENE COUNTY HEALTH, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREENE COUNTY HEALTH - LINTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126994153 | ||||||||
| FaxNumber: | 8126994271 | ||||||||
| Practice Location | |||||||||
| Address1: | GREENE COUNTY HEALTH LINTON | ||||||||
| Address2: | 1600 A ST. NE STE 9 | ||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474411614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128477005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 12/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | ROLL | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 3174727396 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 151987 | 01 | IN | MEDICARE | OTHER | 201359410 | 05 | IN | MEDICAID |