Basic Information
| Provider Information | |||||||||
| NPI: | 1386042653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENE COUNTY HEALTH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 N 1000 W | ||||||||
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| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126994153 | ||||||||
| FaxNumber: | 8126994271 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | JASONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474381323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126659000 | ||||||||
| FaxNumber: | 8126659009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2014 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | PLANO | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8126994153 | ||||||||
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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 | 201359410A | 05 | IN | MEDICAID | 1194191536 | 01 | IN | GROUP NPI | OTHER |