Provider Demographics
NPI:1720360019
Name:GREENE COUNTY GENERAL HOSPITAL LLC
Entity Type:Organization
Organization Name:GREENE COUNTY GENERAL HOSPITAL LLC
Other - Org Name:GREENE COUNTY HEALTH-LINTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MGR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSTERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-366-4606
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-0023
Mailing Address - Country:US
Mailing Address - Phone:812-699-4153
Mailing Address - Fax:570-366-5032
Practice Address - Street 1:1210 N 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5013
Practice Address - Country:US
Practice Address - Phone:812-847-7005
Practice Address - Fax:812-847-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001987A207Q00000X, 207VX0000X, 261QR1300X
IN02001988A207Q00000X, 207VX0000X, 261QR1300X
IN10001157B261QR1300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200153250Medicaid
IN204330Medicare PIN
IN200153250Medicaid