Healthcare Provider Details

I. General information

NPI: 1639234982
Provider Name (Legal Business Name): GREENHILL FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HIGHWAY 64
KILLEN AL
35645
US

IV. Provider business mailing address

351 HIGHWAY 64
KILLEN AL
35645
US

V. Phone/Fax

Practice location:
  • Phone: 256-272-8066
  • Fax: 256-272-8375
Mailing address:
  • Phone: 256-272-8066
  • Fax: 256-272-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVE E WAMPLER
Title or Position: PRESIDENT
Credential: MD
Phone: 256-272-8066