Healthcare Provider Details

I. General information

NPI: 1457696189
Provider Name (Legal Business Name): GREENE COUNTY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N 1000 W
LINTON IN
47441-5013
US

IV. Provider business mailing address

1216 N 1000 W
LINTON IN
47441-5013
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-8664
  • Fax:
Mailing address:
  • Phone: 812-847-8664
  • Fax: 812-847-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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