Healthcare Provider Details

I. General information

NPI: 1174619241
Provider Name (Legal Business Name): SCOTT D GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EAST DECATUR
WEST POINT NE
68788-1566
US

IV. Provider business mailing address

500 EAST DECATUR
WEST POINT NE
68788-1566
US

V. Phone/Fax

Practice location:
  • Phone: 402-372-2477
  • Fax: 402-372-6770
Mailing address:
  • Phone: 402-372-2477
  • Fax: 402-372-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17446
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: