Provider Demographics
NPI:1699753285
Name:GREENE COUNTY HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:GREENE COUNTY HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-384-0044
Mailing Address - Street 1:12 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-1424
Mailing Address - Country:US
Mailing Address - Phone:812-384-0044
Mailing Address - Fax:812-384-0040
Practice Address - Street 1:12 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1424
Practice Address - Country:US
Practice Address - Phone:812-384-0044
Practice Address - Fax:812-384-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN153875Medicare ID - Type UnspecifiedMEDICARE RHC