Healthcare Provider Details

I. General information

NPI: 1851399190
Provider Name (Legal Business Name): GREEN RIVER MEDICAL EQUIPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E BROADWAY ST
CAMPBELLSVILLE KY
42718-2003
US

IV. Provider business mailing address

327 E BROADWAY ST
CAMPBELLSVILLE KY
42718-2003
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-2400
  • Fax:
Mailing address:
  • Phone: 270-465-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ED BAISE
Title or Position: OWNER
Credential: RPH
Phone: 270-465-2400