1588902886 NPI number — GREENTREE HEALTH

Table of content: (NPI 1588902886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588902886 NPI number — GREENTREE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENTREE HEALTH
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:
1588902886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8900 SHOAL CREET BLVD BLDG 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-323-6900
Provider Business Mailing Address Fax Number:
512-524-2251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 IH 10 N STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77707-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-617-0151
Provider Business Practice Location Address Fax Number:
512-524-2251
Provider Enumeration Date:
01/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLACKSTOCK
Authorized Official First Name:
NATHALIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, BILLING
Authorized Official Telephone Number:
512-323-6900

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  04073 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: L8125 , 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)