Provider Demographics
NPI:1538792221
Name:GREENBAX HEALTH SOLUTIONS, LLC
Entity type:Organization
Organization Name:GREENBAX HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VACHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-285-7678
Mailing Address - Street 1:4922 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3142
Mailing Address - Country:US
Mailing Address - Phone:773-417-3784
Mailing Address - Fax:773-417-3784
Practice Address - Street 1:4922 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3142
Practice Address - Country:US
Practice Address - Phone:312-285-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care