MEDICARE: GREEN HORSESHOE HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1710243860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HORSESHOE HEALTHCARE

Provider Business Mailing Address
First Line	:	2145 W HILL ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1923
Country	:	US
Telephone Number	:	502-287-2763
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 W HILL ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1923
Country	:	US
Telephone Number	:	502-287-2763
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY NEAL
Credential	:
Telephone Number	:	502-287-2763

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	04/03/2012

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