Healthcare Provider Details

I. General information

NPI: 1992094833
Provider Name (Legal Business Name): GREENE COUNTY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N JUDGE ST
BLOOMFIELD IN
47424-1231
US

IV. Provider business mailing address

1210 N 1000 W
LINTON IN
47441-5013
US

V. Phone/Fax

Practice location:
  • Phone: 812-384-3508
  • Fax: 812-384-3083
Mailing address:
  • Phone: 812-384-3508
  • Fax: 812-384-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030118A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL PLANO
Title or Position: CFO
Credential:
Phone: 812-699-4153