Healthcare Provider Details

I. General information

NPI: 1407292501
Provider Name (Legal Business Name): GREENE COUNTY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 E FREEDOM DR
NEWBERRY IN
47449-7125
US

IV. Provider business mailing address

1210 N 1000 W
LINTON IN
47441-5013
US

V. Phone/Fax

Practice location:
  • Phone: 812-863-4250
  • Fax: 812-863-4252
Mailing address:
  • Phone: 812-699-4153
  • Fax: 812-699-4271

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