Healthcare Provider Details

I. General information

NPI: 1245836782
Provider Name (Legal Business Name): GREENVILLE FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RED BALL TRL
GREENVILLE IL
62246-2781
US

IV. Provider business mailing address

1000 RED BALL TRL
GREENVILLE IL
62246-2781
US

V. Phone/Fax

Practice location:
  • Phone: 618-664-1240
  • Fax: 618-690-2189
Mailing address:
  • Phone: 618-664-1240
  • Fax: 618-690-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELSEY HOPKINS
Title or Position: MD
Credential: MD
Phone: 618-664-1240