Provider Demographics
NPI:1992094833
Name:GREENE COUNTY HEALTH, INC
Entity type:Organization
Organization Name:GREENE COUNTY HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-699-4153
Mailing Address - Street 1:1210 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5013
Mailing Address - Country:US
Mailing Address - Phone:812-384-3508
Mailing Address - Fax:812-384-3083
Practice Address - Street 1:55 N JUDGE ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1231
Practice Address - Country:US
Practice Address - Phone:812-384-3508
Practice Address - Fax:812-384-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030118A207Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1063744456OtherNPI
IN1326142696OtherNPI
IN151006OtherMEDICARE FQHC
ININ2985OtherMEDICARE PART B (GROUP)
IN201359410DMedicaid
IN1659352995OtherNPI
IN1194191536OtherNPI