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General NPI Number Information
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NPI Number | 1710172861
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Entity Type | Organization
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Legal Business Name | GREENE UROLOGICAL CENTER P.A.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 308 PALMETTO ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7136
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Country | US
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Telephone | 386-426-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 308 PALMETTO ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7136
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Country | US
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Telephone | 386-426-2565
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CAROL GREENE
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Credential |
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Telephone | 386-426-2565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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