1275637951 NPI number — DR. KENNETH K GREENWOOD MD

Table of content: DR. KENNETH K GREENWOOD MD (NPI 1275637951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275637951 NPI number — DR. KENNETH K GREENWOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENWOOD
Provider First Name:
KENNETH
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1275637951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 PONDELLA RD
Provider Second Line Business Mailing Address:
COASTAL BEHAVIORAL HEALTHCARE
Provider Business Mailing Address City Name:
NORTH FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33903-3532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-656-3461
Provider Business Mailing Address Fax Number:
239-656-3462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 PONDELLA RD
Provider Second Line Business Practice Location Address:
COASTAL BEHAVIORAL HEALTHCARE
Provider Business Practice Location Address City Name:
NORTH FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33903-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-656-3461
Provider Business Practice Location Address Fax Number:
239-656-3462
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  29687 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013306 . This is a "CIGNA MCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0100725315 EAST , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3085173 . This is a "MAGELLAN PINNACLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "MENTAL HEALTH NETW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "HIGHLANDS WELLMONT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "INITIAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605W5 . This is a "UBH JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3085173 . This is a "MAGELLAN SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CORPHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3085173 . This is a "MAGELLAN NAVIGATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 334969 . This is a "VALUEOPTIONS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 107340 . This is a "UBH HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112213400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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