Provider Demographics
NPI:1497056220
Name:GREENBO MED SERVICES INC
Entity Type:Organization
Organization Name:GREENBO MED SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-539-6492
Mailing Address - Street 1:1002 LEXINGTON RD
Mailing Address - Street 2:STE 22-286
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1463
Mailing Address - Country:US
Mailing Address - Phone:859-539-6492
Mailing Address - Fax:
Practice Address - Street 1:1002 LEXINGTON RD
Practice Address - Street 2:STE 22-286
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1463
Practice Address - Country:US
Practice Address - Phone:859-539-6492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty