NPIMap

Green Clinic LLC

Organization Active NPI Physical Therapy Clinic/Center · Ruston, LA

NPI 1891801601 · NPPES record last updated Feb 13, 2019

Key facts

NPI
1891801601
Entity type
Organization (NPI type 2)
Primary specialty
Physical Therapy Clinic/Center 261QP2000X
Legal business name
GREEN CLINIC LLC
Practice address
1200 S Farmerville St
Ruston, LA 71270-5941
Phone
(318) 251-6103
Fax
(318) 251-6141
NPI assigned
Aug 22, 2006
Organization subpart
Yes
Parent organization (as reported)
GREEN CLINIC

Authorized official

Name
Mrs. India Carroll
Title
Ceo
Phone
(318) 255-3690

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 36

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050920000235 LA Part B Supplier - Clinic/Group Practice 4789668831 Receives reassigned benefits from 4 practitioners
Practice locations: Jonesboro, LA; Ruston, LA

National Provider Directory

Part of
Green Clinic LLC

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71614

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Yes

Addresses

Primary practice location

1200 S Farmerville St
Ruston, LA 71270-5941

Mailing address

PO Box 1594
Ruston, LA 71273-1594
Phone (318) 251-6103

Other names

  • Green Clinic Rehabilitation Services Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 13, 2019.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550016000000",
    "number": "1891801601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1594",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712731594",
            "telephone_number": "318-251-6103",
            "fax_number": "318-251-6141"
        },
        {
            "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": "318-251-6103",
            "fax_number": "318-251-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREEN CLINIC",
        "enumeration_date": "2006-08-22",
        "last_updated": "2019-02-13",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "INDIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-255-3690",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Clinic Rehabilitation Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Green Clinic Rehabilitation Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

All providers in Ruston, LA · Physical Therapy Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.