Provider Demographics
NPI:1619261336
Name:GREENWOOD PHYSICIANS ASSOCIATES LLP
Entity Type:Organization
Organization Name:GREENWOOD PHYSICIANS ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-881-8248
Mailing Address - Street 1:360 S MADISON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3117
Mailing Address - Country:US
Mailing Address - Phone:317-881-8248
Mailing Address - Fax:317-885-8216
Practice Address - Street 1:360 S MADISON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3117
Practice Address - Country:US
Practice Address - Phone:317-881-8248
Practice Address - Fax:317-885-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201027050AMedicaid
INM100052500Medicare PIN