Healthcare Provider Details

I. General information

NPI: 1598786675
Provider Name (Legal Business Name): GREENFIELD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GREENFIELD AVE STE 4
HANFORD CA
93230-3500
US

IV. Provider business mailing address

460 GREENFIELD AVE STE 4
HANFORD CA
93230-3500
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-1047
  • Fax: 559-582-6693
Mailing address:
  • Phone: 559-582-1047
  • Fax: 559-582-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: GLENN LEON HALL
Title or Position: OWNER
Credential: MD
Phone: 559-582-1047