Healthcare Provider Details

I. General information

NPI: 1578912226
Provider Name (Legal Business Name): JUSTIN JAMES GREINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 LEAVENWORTH ST
OMAHA NE
68105-1026
US

IV. Provider business mailing address

10913 HARDWOOD DR
PAPILLION NE
68046-4561
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone: 319-461-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6161
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD-51161
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT222281
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number34813
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: