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General NPI Number Information
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NPI Number | 1053530329
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Entity Type | Organization
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Legal Business Name | PHILLIP S. GREENE, M.D., IINC.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 638 INDIAN MOUND RD
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City | COLUMBUS
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State | OH
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Zip | 43213-2635
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Country | US
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Telephone | 614-863-1759
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Fax | 614-863-1759
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Provider Business Mailing Address
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Address Line | 638 INDIAN MOUND RD
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City | COLUMBUS
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State | OH
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Zip | 43213-2635
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Country | US
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Telephone | 614-863-1759
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Fax | 614-863-1759
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP SHELDON GREENE
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Credential | M.D.
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Telephone | 614-863-1759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35-04-3686-G
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License Number State | OH
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