Green-Mack, Thelma Lynette
Green-Mack, Thelma Lynette is an individual health care provider with primary practice located at 3850 Shore Drive Suiote 305, Indianapolis IN 46254-5621. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is her primary health care specialty. Green-Mack, Thelma Lynette can be contacted via phone (317) 920-3220.Contact Information
Primary practice address
3850 Shore Drive Suiote 305
Indianapolis IN 46254-5621
Phone: (317) 920-3220
Fax: (317) 920-3221
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | 01037601B | Indiana |
| Allopathic & Osteopathic Physicians / Pain Medicine | 2081P2900X | 01037601 | Indiana |
| Allopathic & Osteopathic Physicians / Addiction Medicine | 207RA0401X | 01037601 | Indiana |
Profile Details
| NPI number | 1841358017 |
|---|---|
| LBN Legal business name | Green-Mack, Thelma Lynette |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 4th, 2006 |
| Last updated | Mar 9th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841358017 | NPPES |
| Indiana | MEDICAID | 100130200 | |
| Indiana | Other | 250010985 | |
| Indiana | Other | 000000092241 | |
| Indiana | Other | 1841358017 |
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