Provider Demographics
NPI:1558402834
Name:GREENTREE PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:GREENTREE PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-981-7900
Mailing Address - Street 1:207 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:#C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1711
Mailing Address - Country:US
Mailing Address - Phone:812-981-7900
Mailing Address - Fax:812-981-7042
Practice Address - Street 1:207 E LEWIS AND CLARK PKWY
Practice Address - Street 2:#C
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1711
Practice Address - Country:US
Practice Address - Phone:812-981-7900
Practice Address - Fax:812-981-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200912100Medicaid
IN217090Medicare PIN