Provider Demographics
NPI:1215061981
Name:GREENSBURG MEDICAL ASSOCIATES P.C.
Entity type:Organization
Organization Name:GREENSBURG MEDICAL ASSOCIATES P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-663-8079
Mailing Address - Street 1:995 N MICHIGAN AVE
Mailing Address - Street 2:STE.95
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1487
Mailing Address - Country:US
Mailing Address - Phone:812-663-8079
Mailing Address - Fax:
Practice Address - Street 1:995 N MICHIGAN AVE
Practice Address - Street 2:STE.95
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1487
Practice Address - Country:US
Practice Address - Phone:812-663-8079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENSBURG MEDICAL ASSOCIATES P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100098460AMedicaid
IN100098460AMedicaid