Healthcare Provider Details

I. General information

NPI: 1063632099
Provider Name (Legal Business Name): GREENWICH FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W MAIN ST
GREENWICH OH
44837-1030
US

IV. Provider business mailing address

65 W MAIN ST
GREENWICH OH
44837-1030
US

V. Phone/Fax

Practice location:
  • Phone: 419-752-1811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH C LEE
Title or Position: OWNER
Credential: M.D.
Phone: 419-752-1811