Basic Information
| Provider Information | |||||||||
| NPI: | 1598786675 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREENFIELD MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 GREENFIELD AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595821047 | ||||||||
| FaxNumber: | 5595826693 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 GREENFIELD AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595821047 | ||||||||
| FaxNumber: | 5595826693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | LEON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5595821047 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.