Healthcare Provider Details

I. General information

NPI: 1376587311
Provider Name (Legal Business Name): KEITH GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CANTERBURY DR STE 206
HAYS KS
67601-2281
US

IV. Provider business mailing address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 785-623-5940
  • Fax: 785-623-5680
Mailing address:
  • Phone: 785-623-5940
  • Fax: 785-623-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-24431
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0424431
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number04-24431
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number04-24431
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: