Provider Demographics
NPI:1972532109
Name:GREENE COUNTY PRIMARY CARE, PC
Entity Type:Organization
Organization Name:GREENE COUNTY PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-627-8582
Mailing Address - Street 1:430 E OAKVIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-9729
Mailing Address - Country:US
Mailing Address - Phone:724-627-8582
Mailing Address - Fax:724-627-7756
Practice Address - Street 1:430 E OAKVIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-9729
Practice Address - Country:US
Practice Address - Phone:724-627-8582
Practice Address - Fax:724-627-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418743207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019036410001Medicaid
PA538628OtherAETNA
PA1393789OtherBCBS
PA1528302OtherGATEWAY
PA538628OtherAETNA
PA0019036410001Medicaid