Organization
GREEN CLINIC LLC
Active
Parent organization
GREEN CLINIC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREEN CLINIC LLC
Authorized official
MRS. LORI S KEEN (CEO)
(318) 251-6304
Entity
Organization
Contact information
Practice address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 251-6216
Mailing address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 251-6216
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1542580
—
LA
01
—
690004423
RR MEDICARE LAB
LA
01
—
C5055
BCBS LAB
LA
Enumeration date
01/11/2006
Last updated
12/27/2024
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