MEDICARE: MARK S. GREER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	3261	TX
2	324500000X	Substance Abuse Rehabilitation Facility	3260	TX

General Provider Information

NPI Number	:	1295065472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK S. GREER

Provider Business Mailing Address
First Line	:	3305 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2690
Country	:	US
Telephone Number	:	936-559-9422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2690
Country	:	US
Telephone Number	:	936-559-9422
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. MARK GREER
Credential	:
Telephone Number	:	936-559-9422

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	03/08/2010

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