MEDICARE: GREENE COUNTY FAMILY PRACTICE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD068043L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1508380	OTHER	PA	GATEWAY
3	094575	OTHER	PA	AETNA
4	781907	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1104855337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE COUNTY FAMILY PRACTICE, PC

Provider Business Mailing Address
First Line	:	430 E OAKVIEW DR
Second Line	:	SUITE A
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-9729
Country	:	US
Telephone Number	:	724-627-8582
Fax Number	:	724-627-7756

Provider Business Practice Location Address
First Line	:	430 E OAKVIEW DR
Second Line	:	SUITE A
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-9729
Country	:	US
Telephone Number	:	724-627-8582
Fax Number	:	724-627-7756

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMY R NEGREY
Credential	:	MD
Telephone Number	:	724-627-8582

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	04/20/2008

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Directions to “GREENE COUNTY FAMILY PRACTICE, PC ” Practice Location

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