Healthcare Provider Details

I. General information

NPI: 1942643507
Provider Name (Legal Business Name): TIMOTHY FRANCIS GREENER R.T.(R)(MR)(ARRT)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2013
Last Update Date: 04/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

1313 OUT OF BOUNDS RD
MUSKOGEE OK
74403-8488
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3000
  • Fax:
Mailing address:
  • Phone: 918-869-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number271305
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number271305
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number271305
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: