Green Clinic LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GREEN CLINIC LLC

Practice address

1200 S Farmerville St
Ruston, LA 71270-5941

Phone

(318) 251-6216

NPI assigned

Jan 11, 2006

Last updated

Dec 27, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

GREEN CLINIC LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lori S Keen

Title

Ceo

Phone

(318) 251-6304

Specialties & licenses 1

Addresses

Other identifiers 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Green Clinic

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1457330185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S FARMERVILLE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705941",
            "telephone_number": "318-251-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S FARMERVILLE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705941",
            "telephone_number": "318-251-6216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREEN CLINIC LLC",
        "enumeration_date": "2006-01-11",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "KEEN",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-251-6304",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LAB",
            "identifier": "C5055",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1542580",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE LAB",
            "identifier": "690004423",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Grant
• Alexis Gray, RD, LDN
• Latrice Gray
• Rel Larkin Gray, MD
• Green Clinic LLC (Green Clinic Pharmacy)
• Green Clinic LLC (Quickcare of Ruston)
• Green Clinic LLC
• Green Clinic LLC (Green Clinic Rehabilitation Services)
• Green Clinic Surgical Center
• Green Clinic Surgical Hospital Crna Group

• Clinical Medical Laboratory in Ruston, LA
• Providers in Ruston, LA by specialty
• Clinical Medical Laboratory in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.