1558361329 NPI number — STEPHEN GREER DO INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558361329 NPI number — STEPHEN GREER DO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN GREER DO INC
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:
1558361329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 N LUDLOW ST
Provider Second Line Business Mailing Address:
SUITE 1125
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45402-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-223-2911
Provider Business Mailing Address Fax Number:
937-461-5102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 N LUDLOW ST
Provider Second Line Business Practice Location Address:
SUITE 1125
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-223-2911
Provider Business Practice Location Address Fax Number:
937-461-5102
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/SURGEON
Authorized Official Telephone Number:
937-223-2911

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  34-00-3010 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0682480 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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