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NPI Code Detail

MEDICARE: AMY ELAINE GRECO P.A.

MEDICARE: AMY ELAINE GRECO P.A.
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
1363A00000XPhysician Assistant766OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083687750
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELAINE GRECO P.A.
Provider Business Mailing Address
First Line : 820 NW 13TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-6827
Country : US
Telephone Number : 405-604-4380
Fax Number :
Provider Business Practice Location Address
First Line : 5501 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-2074
Country : US
Telephone Number : 405-604-4380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 09/22/2016

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