Provider Demographics
NPI:1437751567
Name:GREENWOOD MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:GREENWOOD MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:III
Authorized Official - Credentials:ARNP
Authorized Official - Phone:515-480-7987
Mailing Address - Street 1:500 N VALLEY DR UNIT 804
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1625
Mailing Address - Country:US
Mailing Address - Phone:515-480-7987
Mailing Address - Fax:
Practice Address - Street 1:500 N VALLEY DR UNIT 804
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-1625
Practice Address - Country:US
Practice Address - Phone:515-480-7987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1508477316Medicaid