Organization
GREEN VALLEY RURAL CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DJIEN H. SO (ADMINISTRATOR)
(606) 432-3221
Entity
Organization
Contact information
Practice address
156 ISLAND CREEK RD, PIKEVILLE, KY 41501-9340
(606) 432-3221
(606) 437-0438
Mailing address
PO BOX 2748, PIKEVILLE, KY 41502-2748
(606) 432-3221
(606) 437-0438
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65925638
—
KY
Enumeration date
07/19/2007
Last updated
11/01/2012
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