1306024823 NPI number — THOMAS W GREENE, O.D.,P.C.

Table of content: (NPI 1306024823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306024823 NPI number — THOMAS W GREENE, O.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS W GREENE, O.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306024823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76230-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-872-5417
Provider Business Mailing Address Fax Number:
940-872-6754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E LONDON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76230-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-872-5417
Provider Business Practice Location Address Fax Number:
940-872-6754
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
940-872-5417

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  2610T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 219146201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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