MEDICARE: GREEN HILLS COMMUNITY ACTION AGENCY

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	261QA0005X	Ambulatory Family Planning Facility		MO

General Provider Information

NPI Number	:	1538329529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HILLS COMMUNITY ACTION AGENCY

Provider Business Mailing Address
First Line	:	PO BOX 278
Second Line	:	1506 OKLAHOMA AVENUE
City	:	TRENTON
State	:	MO
Zip	:	64683-2587
Country	:	US
Telephone Number	:	660-359-2855
Fax Number	:	660-359-6619

Provider Business Practice Location Address
First Line	:	1506 OKLAHOMA AVENUE
Second Line	:
City	:	TRENTON
State	:	MO
Zip	:	64683-2587
Country	:	US
Telephone Number	:	660-359-2855
Fax Number	:	660-359-6619

Authorized Official
Title or Position	:	WOMEN'S HEALTH PROGRAM DIRECTOR
Name	:	MS. JENNY SUE DEAN-BATSON
Credential	:	WHNP BC
Telephone Number	:	660-359-2855

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	06/12/2008

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