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General NPI Number Information
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NPI Number | 1235451170
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Entity Type | Organization
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Legal Business Name | THE GREEN MEDICAL CENTER
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 1790 TOWN PARK BLVD SUITE D
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City | UNIONTOWN
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State | OH
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Zip | 44685-7972
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Country | US
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Telephone | 330-563-4424
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Fax | 330-563-4429
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Provider Business Mailing Address
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Address Line | 1790 TOWN PARK BLVD SUITE D
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City | UNIONTOWN
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State | OH
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Zip | 44685-7972
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Country | US
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Telephone | 330-563-4424
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Fax | 330-563-4429
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Authorized Official
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Title or Position | OWNER
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Name | JANICE MOOK
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Credential |
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Telephone | 330-563-4424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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