Basic Information
| Provider Information | |||||||||
| NPI: | 1821630724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENWICH MEDICAL ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 BUTTERFIELD RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252799 | ||||||||
| FaxNumber: | 8338425469 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W PUTNAM AVE STE 435 | ||||||||
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| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068306086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038617890 | ||||||||
| FaxNumber: | 2038617898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2019 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | ESPARZA | ||||||||
| AuthorizedOfficialFirstName: | LORENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6307252764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.