MEDICARE: QUALITY OF LIFE CLINIC LLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1912477605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY OF LIFE CLINIC LLC

Provider Business Mailing Address
First Line	:	200 W MAIN ST UNIT 307
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9370
Country	:	US
Telephone Number	:	212-945-7252
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 N END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10282-1131
Country	:	US
Telephone Number	:	212-791-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. STEVEN E GREER
Credential	:	MD
Telephone Number	:	212-945-7252

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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