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General NPI Number Information
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NPI Number | 1538792221
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Entity Type | Organization
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Legal Business Name | GREENBAX HEALTH SOLUTIONS, LLC
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Dates
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Enumeration Date | 02/20/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 4922 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60651-3142
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Country | US
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Telephone | 312-285-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 4922 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60651-3142
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Country | US
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Telephone | 773-417-3784
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Fax | 773-417-3784
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. GREGORY C VACHON
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Credential | MD
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Telephone | 312-285-7678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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