Provider Demographics
NPI:1245754043
Name:GREEN RIVER MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:GREEN RIVER MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-522-2379
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:ROCKVALE
Mailing Address - State:TN
Mailing Address - Zip Code:37153-0471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 ROBERT ROSE DR STE F
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6361
Practice Address - Country:US
Practice Address - Phone:615-522-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care