Provider Demographics
NPI:1184731903
Name:GREENFIELD NEUROLOGY, LLC
Entity type:Organization
Organization Name:GREENFIELD NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-462-6066
Mailing Address - Street 1:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-871-8262
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:300 E BOYD AVE
Practice Address - Street 2:SUITE #230
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2834
Practice Address - Country:US
Practice Address - Phone:317-462-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200804760Medicaid
IN200804760Medicaid
D94616Medicare UPIN