Greencastle Wound & Diabetic Foot Care Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

71002412A Issued in IN

Legal business name

GREENCASTLE WOUND & DIABETIC FOOT CARE CLINIC, LLC

Practice address

305 Medic Way
Greencastle, IN 46135-2296

Phone

(765) 720-7085

NPI assigned

Dec 14, 2007

Last updated

May 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amelia Estalilla-Quiz, NP-C

Title

Owner/President

Phone

(765) 720-7085

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1942483896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 MEDIC WAY",
            "city": "GREENCASTLE",
            "state": "IN",
            "postal_code": "461352296",
            "telephone_number": "765-720-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 MEDIC WAY",
            "city": "GREENCASTLE",
            "state": "IN",
            "postal_code": "461352296",
            "telephone_number": "765-720-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENCASTLE WOUND & DIABETIC FOOT CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "ESTALILLA-QUIZ",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "765-720-7085",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IN",
            "license": "71002412A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Greencastle Pediatric Dentistry, P.C.
• Jessica Gregory, DPT
• Tina Marie Grzesiek, MED, LMHC
• Denisha Gude, RD, CDCES
• Pamela Guthrie, PHD, HSPP
• Brenan Hall

• Clinic/Center in Greencastle, IN
• Providers in Greencastle, IN by specialty
• Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.