Provider Demographics
| NPI: | 1942703004 |
|---|---|
| Name: | GREENE COUNTY GENERAL HOSPITAL |
| Entity Type: | Organization |
| Organization Name: | GREENE COUNTY GENERAL HOSPITAL |
| Other - Org Name: | GREENE COUNTY GENERAL HOSPITAL PHYSICIAN GROUP |
| Other - Org Type: | Other Name |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | BRENDA |
| Authorized Official - Middle Name: | LEA |
| Authorized Official - Last Name: | REETZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 812-847-5212 |
| Mailing Address - Street 1: | 1185 N 1000 W |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LINTON |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 47441-5282 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 812-847-5212 |
| Mailing Address - Fax: | 812-847-6166 |
| Practice Address - Street 1: | 1185 N 1000 W |
| Practice Address - Street 2: | |
| Practice Address - City: | LINTON |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 47441-5282 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 812-847-5212 |
| Practice Address - Fax: | 812-847-6166 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | GREENE COUNTY GENERAL HOSPITAL |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2018-03-15 |
| Last Update Date: | 2023-03-15 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 213ES0000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | Group - Multi-Specialty |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IN | 300014765 | Medicaid |
