GREEN CLINIC LLC
NPI 1831178755
Family Medicine in Ruston, LA

Q: What is Green Clinic LLC's NPI number?

The NPI number for Green Clinic LLC is 1831178755. It was assigned to this organization in the NPPES registry on January 10, 2006.

Q: What is Green Clinic LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Green Clinic LLC was last updated on February 22, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since January 10, 2006CLIA Certified · 2 labs

1200 S FARMERVILLE ST, RUSTON, LA 71270(318) 255-3690 Get Directions Write a Review

NPPES record last updated: February 22, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 10, 2023, Jan 24, 2023, Apr 23, 2019 (3 updates tracked since 2019).

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About Green Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREEN CLINIC LLC (NPI 1831178755) is a healthcare organization registered as a family medicine in Ruston, Louisiana and active in the NPI registry since January 2006. The organization holds 2 active CLIA laboratory certificates, maintains 6 additional practice locations, and lists Lori S Keen, Ceo, as its authorized official.

NPPES Registry Identity

NPI1831178755

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameGREEN CLINIC LLC

Location Address1200 S FARMERVILLE STRuston, LA 71270-5941

Mailing Address1200 S Farmerville StRuston, LA 71270-5941 · (318) 255-3690

Phone(318) 255-3690

Organization SubpartNo

Authorized OfficialLori S KeenCeo · (318) 251-6304

Enumeration DateJanuary 10, 2006

Last NPPES UpdateFebruary 22, 20243 updates tracked since enumeration

NPPES CertifiedFebruary 22, 2024

✔ NPI 1831178755 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedDietitian, RegisteredTaxonomy 133V00000X

Also ListedNeuromusculoskeletal Medicine, Sports MedicineTaxonomy 204C00000X

Also ListedOral & Maxillofacial SurgeryTaxonomy 204E00000X

Also ListedDermatologyTaxonomy 207N00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedNuclear MedicineTaxonomy 207U00000X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedOphthalmologyTaxonomy 207W00000X

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

Also ListedOtolaryngologyTaxonomy 207Y00000X

Also ListedPediatricsTaxonomy 208000000X

Also ListedPhysical Medicine & RehabilitationTaxonomy 208100000X

Also ListedPreventive Medicine · Preventive Medicine/Occupational Environmental MedicineTaxonomy 2083P0500X

Also ListedPodiatristTaxonomy 213E00000X

1200 S FARMERVILLE ST, Ruston, LA 71270

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Secondary Practice Locations 6

Location 13 Medical Plaza PlMinden, LA 71055-3330 · Phone (318) 639-4001 · Fax (318) 639-4002

Location 2620 E College StHomer, LA 71040-3202 · Phone (318) 927-2024

Location 3411 E Vaughn Ave Ste 103Ruston, LA 71270-5975 · Phone (318) 255-9414 · Fax (318) 255-9434

Location 41402 Celebrity DrRuston, LA 71270-3878 · Phone (318) 255-1515 · Fax (318) 255-2866

Location 5411 E Vaughn Ave Ste 200Ruston, LA 71270-5977 · Phone (318) 232-1570 · Fax (318) 251-6230

Location 64707 Quitman HwyHodge, LA 71247 · Phone (318) 395-1168 · Fax (318) 395-1170

Other Identifiers 3

Medicaid1006858LA

OtherCS0281LA · Rr Medicare Group

Other06185LA · Bcbs Group

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D1026659

Green Clinic Jonesboro · Hodge, LA

Active · expires Jun 9, 2028

CLIA Number19D1026659

Laboratory TypePhysician Office

Certificate Effective DateJune 10, 2026

Certificate Expiration DateJune 9, 2028

Laboratory DirectorShane M. Mcvay

Laboratory Phone(318) 395-1168

Laboratory LocationGreen Clinic Jonesboro4707 Quitman Highway, Hodge, LA 71247

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 19D1044231

Green Clinic Northside · Ruston, LA

Active · expires Aug 14, 2027

CLIA Number19D1044231

Laboratory TypePhysician Office

Certificate Effective DateAugust 15, 2025

Certificate Expiration DateAugust 14, 2027

Laboratory DirectorMichael S. Phillips MD

Laboratory Phone(318) 255-1515

Laboratory LocationGreen Clinic Northside1402 Celebrity Drive, Ruston, LA 71270

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PAUL M NOVAKOVICH MD

Orthopaedic Surgery