Provider Demographics
NPI:1528445566
Name:GREEN CROSS FAMILY CARE
Entity type:Organization
Organization Name:GREEN CROSS FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:205-936-1386
Mailing Address - Street 1:5510 HIGHWAY 280 STE 216
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6547
Mailing Address - Country:US
Mailing Address - Phone:205-936-1386
Mailing Address - Fax:
Practice Address - Street 1:5510 HIGHWAY 280 STE 216
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6547
Practice Address - Country:US
Practice Address - Phone:205-936-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054204261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care