Provider Demographics
NPI:1932978459
Name:GREENWOOD FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:GREENWOOD FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TICHENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-490-6264
Mailing Address - Street 1:3352 W SOUTH JORDAN PKWY # 8
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8938
Mailing Address - Country:US
Mailing Address - Phone:385-490-6264
Mailing Address - Fax:
Practice Address - Street 1:3352 W SOUTH JORDAN PKWY # 8
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8938
Practice Address - Country:US
Practice Address - Phone:385-490-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center