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General NPI Number Information
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NPI Number | 1316188444
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Entity Type | Organization
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Legal Business Name | INSURANCE SERVICES GREEN, CO.
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 1200 SMITH ST STE 1600
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City | HOUSTON
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State | TX
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Zip | 77002-4313
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Country | US
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Telephone | 713-353-4634
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 SMITH ST STE 1600
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City | HOUSTON
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State | TX
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Zip | 77002-4313
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Country | US
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Telephone | 713-353-4634
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES M FORTENBERRY
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Credential |
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Telephone | 713-353-4634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 04322567
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License Number State | TX
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