Provider Demographics
NPI:1629031885
Name:GREEN HILLS FAMILY HEALTH CARE INC
Entity Type:Organization
Organization Name:GREEN HILLS FAMILY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEGG
Authorized Official - Last Name:GORBA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-530-9155
Mailing Address - Street 1:1150 GLENLIVET DRIVE
Mailing Address - Street 2:SUITE A17
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106
Mailing Address - Country:US
Mailing Address - Phone:610-530-9155
Mailing Address - Fax:610-530-4495
Practice Address - Street 1:1150 GLENLIVET DRIVE
Practice Address - Street 2:SUITE A17
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:610-530-9155
Practice Address - Fax:610-530-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080195420OtherPALMETTO GBA
1464675OtherHIGHMARK BLUE SHIELD
PA50011842OtherCAPITAL BLUE CROSS
F87264OtherUPIN
PA50011842OtherCAPITAL BLUE CROSS