1265426225 NPI number — MS. YVETTE M RYAN-GREEN M.D.

Table of content: MS. YVETTE M RYAN-GREEN M.D. (NPI 1265426225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265426225 NPI number — MS. YVETTE M RYAN-GREEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN-GREEN
Provider First Name:
YVETTE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCREA-RYAN
Provider Other First Name:
YVETTE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265426225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3702
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBRING
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33871-3702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-471-1413
Provider Business Mailing Address Fax Number:
863-471-1416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 RYANT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBRING
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33872-4075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-471-1413
Provider Business Practice Location Address Fax Number:
863-471-1416
Provider Enumeration Date:
09/07/2005

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: 207L00000X , with the licence number:  ME73833 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252541100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41638 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 119718100 . 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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