Provider Demographics
NPI:1922268051
Name:GREENE FAMILY MEDICINE, APMC
Entity Type:Organization
Organization Name:GREENE FAMILY MEDICINE, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-594-8958
Mailing Address - Street 1:2967 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5740
Mailing Address - Country:US
Mailing Address - Phone:337-594-8958
Mailing Address - Fax:337-594-8987
Practice Address - Street 1:216 PARK ST
Practice Address - Street 2:
Practice Address - City:KROTZ SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70750
Practice Address - Country:US
Practice Address - Phone:337-594-8958
Practice Address - Fax:337-594-8987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE FAMILY MEDICINE, APMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-12
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420921Medicaid
LA1420921Medicaid