Healthcare Provider Details

I. General information

NPI: 1912432832
Provider Name (Legal Business Name): GREENE COUNTY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
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

8754 N 1380 W
JASONVILLE IN
47438-6063
US

V. Phone/Fax

Practice location:
  • Phone: 812-699-4153
  • Fax: 812-699-4271
Mailing address:
  • Phone: 812-847-7005
  • Fax: 812-847-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007062A
License Number StateIN

VIII. Authorized Official

Name: MS. TARYN E INMAN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 812-699-4153