MEDICARE: JANE ELIZABETH GREENWOOD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA06705	TX

General Provider Information

NPI Number	:	1053635532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE ELIZABETH GREENWOOD PA-C

Provider Business Mailing Address
First Line	:	1425 CHIPPEWA DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-3710
Country	:	US
Telephone Number	:	469-583-5630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 VIRGINIA PKWY
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4917
Country	:	US
Telephone Number	:	972-542-3300
Fax Number	:	972-542-4311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	10/09/2013

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