1992094833 NPI number — GREENE COUNTY HEALTH, INC

Table of content: (NPI 1992094833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992094833 NPI number — GREENE COUNTY HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENE COUNTY HEALTH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992094833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1210 N 1000 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47441-5013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-384-3508
Provider Business Mailing Address Fax Number:
812-384-3083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 N JUDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47424-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-384-3508
Provider Business Practice Location Address Fax Number:
812-384-3083
Provider Enumeration Date:
03/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PLANO
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
812-699-4153

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01030118A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063744456 . This is a "NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1326142696 . This is a "NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 151006 . This is a "MEDICARE FQHC" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: IN2985 . This is a "MEDICARE PART B (GROUP)" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201359410D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659352995 . This is a "NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1194191536 . This is a "NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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