Provider Demographics
NPI:1407292501
Name:GREENE COUNTY HEALTH, INC
Entity Type:Organization
Organization Name:GREENE COUNTY HEALTH, INC
Other - Org Name:
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:812-699-4153
Mailing Address - Fax:812-699-4271
Practice Address - Street 1:1985 E FREEDOM DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:IN
Practice Address - Zip Code:47449-7125
Practice Address - Country:US
Practice Address - Phone:812-863-4250
Practice Address - Fax:812-863-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201359410EMedicaid
IN1194191536OtherGROUP NPI