Provider Demographics
NPI:1235451170
Name:THE GREEN MEDICAL CENTER
Entity Type:Organization
Organization Name:THE GREEN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-563-4424
Mailing Address - Street 1:1790 TOWN PARK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7972
Mailing Address - Country:US
Mailing Address - Phone:330-563-4424
Mailing Address - Fax:330-563-4429
Practice Address - Street 1:1790 TOWN PARK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7972
Practice Address - Country:US
Practice Address - Phone:330-563-4424
Practice Address - Fax:330-563-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty