Healthcare Provider Details

I. General information

NPI: 1720360019
Provider Name (Legal Business Name): GREENE COUNTY GENERAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N 1000 W
LINTON IN
47441-5013
US

IV. Provider business mailing address

PO BOX 23
GREENSBURG IN
47240-0023
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-7005
  • Fax: 812-847-5305
Mailing address:
  • Phone: 812-699-4153
  • Fax: 570-366-5032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001988A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number02001987A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number02001988A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number02001987A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number02001988A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number10001157B
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001157B
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001987A
License Number StateIN

VIII. Authorized Official

Name: LAURIE FENSTERMACHER
Title or Position: CREDENTIALING MGR
Credential:
Phone: 570-366-4606