Organization
GREENE COUNTY HEALTH, INC
Active
Other names
GREENE COUNTY HEALTH BLOOMFIELD
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL PLANO (CFO)
(812) 699-4153
Entity
Organization
Contact information
Practice address
55 N JUDGE ST, BLOOMFIELD, IN 47424-1231
(812) 384-3508
(812) 384-3083
Mailing address
1210 N 1000 W, LINTON, IN 47441-5013
(812) 384-3508
(812) 384-3083
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01030118A
IN
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063744456
NPI
IN
01
—
1194191536
NPI
IN
01
—
1326142696
NPI
IN
01
—
151006
MEDICARE FQHC
IN
01
—
1659352995
NPI
IN
05
—
201359410D
—
IN
01
—
IN2985
MEDICARE PART B (GROUP)
IN
Enumeration date
03/31/2011
Last updated
02/02/2018
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