Provider Demographics
NPI:1639234982
Name:GREENHILL FAMILY CLINIC, LLC
Entity Type:Organization
Organization Name:GREENHILL FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-272-8066
Mailing Address - Street 1:351 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645
Mailing Address - Country:US
Mailing Address - Phone:256-272-8066
Mailing Address - Fax:256-272-8375
Practice Address - Street 1:351 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645
Practice Address - Country:US
Practice Address - Phone:256-272-8066
Practice Address - Fax:256-272-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDF5641OtherMEDICARE RAILROAD
AL529931670Medicaid
FL612248600OtherDEPARTMENT OF LABOR
SC=========OtherTRICARE
SCDF5641OtherMEDICARE RAILROAD