Basic Information
| Provider Information | |||||||||
| NPI: | 1720360019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENE COUNTY GENERAL HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | GREENE COUNTY HEALTH-LINTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23 | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472400023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126994153 | ||||||||
| FaxNumber: | 5703665032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128477005 | ||||||||
| FaxNumber: | 8128475305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2011 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | FENSTERMACHER | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MGR | ||||||||
| AuthorizedOfficialTelephone: | 5703664606 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02001988A | IN | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207VX0000X | 02001987A | IN | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207VX0000X | 02001988A | IN | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 261QR1300X | 02001987A | IN | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QR1300X | 02001988A | IN | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QR1300X | 10001157B | IN | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 363A00000X | 10001157B | IN | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | 02001987A | IN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200153250 | 05 | IN | MEDICAID |