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Organization
GREEN CLINIC LLC
Active
Organization
GREEN CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI S KEEN (CEO)
(318) 251-6304
Entity
Organization
Contact information
Practice address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 255-3690
Mailing address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 255-3690
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
NULL
133V00000X
Registered Dietitian
—
—
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
NULL
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207U00000X
Nuclear Medicine Physician
—
NULL
207U00000X
Nuclear Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
—
NULL
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06185
BCBS GROUP
LA
05
—
1006858
—
LA
01
—
=========
BCBS GROUP
LA
01
—
CS0281
RR MEDICARE GROUP
LA
Enumeration date
01/10/2006
Last updated
02/22/2024
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