Healthcare Provider Details

I. General information

NPI: 1770670671
Provider Name (Legal Business Name): GREENE-DAVIS ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NW SOUTH OUTER RD SUITE 116
BLUE SPRINGS MO
64015-3072
US

IV. Provider business mailing address

1200 NW SOUTH OUTER RD SUITE 116
BLUE SPRINGS MO
64015-3072
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-5179
  • Fax: 816-246-4884
Mailing address:
  • Phone: 816-228-5179
  • Fax: 816-246-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberCE004130
License Number StateMO

VIII. Authorized Official

Name: DR. MICHAEL SMITH GREENE
Title or Position: PRESIDENT/PARTNER
Credential: DC
Phone: 816-228-5179