| Green Clinic Llc | |
|
1809 Northpointe Ln Ste 102 Ruston LA 71270-3852 | |
| (318) 255-3762 | |
| Not Available |
| Full Name | Green Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1809 Northpointe Ln Ste 102, Ruston, Louisiana |
| Authorized Official Name and Position | Christopher Anding Stegall (CFO) |
| Authorized Official Contact | 3182516304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Clinic Llc 1200 S Farmerville St Ruston LA 71270-5941 Ph: () - | Green Clinic Llc 1809 Northpointe Ln Ste 102 Ruston LA 71270-3852 Ph: (318) 255-3762 |
| NPI Number | 1578021093 |
|---|---|
| Provider Enumeration Date | 03/04/2019 |
| Last Update Date | 03/04/2019 |
| Medicare PECOS PAC ID | 4789668831 |
|---|---|
| Medicare Enrollment ID | O20190426001005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578021093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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