MEDICARE: AMY A GREEN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1082067	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	430079110	OTHER	AL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619959889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY A GREEN CRNA

Provider Business Mailing Address
First Line	:	2151 OLD ROCKY RIDGE
Second Line	:	#106
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216
Country	:	US
Telephone Number	:	205-989-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 BROOKWOOD MEDICAL CENTER DRIVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216
Country	:	US
Telephone Number	:	205-989-1080
Fax Number	:	205-989-1087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	09/03/2010

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Directions to “ AMY A GREEN CRNA” Practice Location

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