Basic Information
| Provider Information | |||||||||
| NPI: | 1528274941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENCASTLE INTERNAL MEDICINE & PRIMARY CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 MEDIC WAY | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656534633 | ||||||||
| FaxNumber: | 7656530562 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 MEDIC WAY | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656534633 | ||||||||
| FaxNumber: | 7656530562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | QUIZ | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7656534633 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01048550 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.