Provider Demographics
NPI:1104855337
Name:GREENE COUNTY FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:GREENE COUNTY FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEGREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-627-8582
Mailing Address - Street 1:430 E OAKVIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-9729
Mailing Address - Country:US
Mailing Address - Phone:724-627-8582
Mailing Address - Fax:724-627-7756
Practice Address - Street 1:430 E OAKVIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-9729
Practice Address - Country:US
Practice Address - Phone:724-627-8582
Practice Address - Fax:724-627-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068043L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0177896460001Medicaid
PA1508380OtherGATEWAY
PA094575OtherAETNA
PA781907OtherBCBS
PA094575OtherAETNA
PA1508380OtherGATEWAY