Healthcare Provider Details

I. General information

NPI: 1104814276
Provider Name (Legal Business Name): GREENE EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N MONROE DR
XENIA OH
45385-1619
US

IV. Provider business mailing address

5620 SOUTHWYCK BLVD
TOLEDO OH
43614-1501
US

V. Phone/Fax

Practice location:
  • Phone: 937-372-8011
  • Fax: 937-376-7399
Mailing address:
  • Phone: 800-288-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2003781
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: DR. CHARLES S DIXON
Title or Position: HEAD PHYSICIAN
Credential: MD
Phone: 937-372-8011