MEDICARE: KEVIN GREENE

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	237700000X	Hearing Instrument Specialist	5225	FL

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	:	1891212361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GREENE

Provider Business Mailing Address
First Line	:	8800 SE SUNNYSIDE RD STE 300N
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-5703
Country	:	US
Telephone Number	:	281-286-2999
Fax Number	:	512-607-4893

Provider Business Practice Location Address
First Line	:	269 S FEDERAL HWY
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4161
Country	:	US
Telephone Number	:	954-426-2500
Fax Number	:

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

Provider Enumeration Date	:	08/25/2017
Last Update Date	:	08/25/2017

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Directions to “ KEVIN GREENE ” Practice Location

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