Basic Information
| Provider Information | |||||||||
| NPI: | 1396336970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENVILLE FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 RED BALL TRL | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622462781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 RED BALL TRL | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622462781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2021 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOPKINS | ||||||||
| AuthorizedOfficialFirstName: | KELSEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6186641240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.