Provider Demographics
NPI:1336761428
Name:GREENSTONE PHYSICIANS LLC
Entity Type:Organization
Organization Name:GREENSTONE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-494-9914
Mailing Address - Street 1:280 ISLAND AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1802
Mailing Address - Country:US
Mailing Address - Phone:530-494-9914
Mailing Address - Fax:
Practice Address - Street 1:280 ISLAND AVE APT 604
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1802
Practice Address - Country:US
Practice Address - Phone:727-424-4721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty