MEDICARE: GREENWOOD SOUTH, LLC

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	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1063179174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD SOUTH, LLC

Provider Business Mailing Address
First Line	:	1005 S CROWLEY RD STE R
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-3698
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4779
Country	:	US
Telephone Number	:	817-566-1232
Fax Number	:	817-984-5434

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	JORDAN TYLER
Credential	:
Telephone Number	:	817-566-1232

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	04/04/2022

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Directions to “GREENWOOD SOUTH, LLC ” Practice Location

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