MEDICARE: CAL W GREENLAW MD PC

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	207R00000X	Internal Medicine Physician	R3F02	MO

General Provider Information

NPI Number	:	1184861478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL W GREENLAW MD PC

Provider Business Mailing Address
First Line	:	103 11TH ST
Second Line	:	SUITE 16
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-646-4345
Fax Number	:	660-646-6024

Provider Business Practice Location Address
First Line	:	103 11TH ST
Second Line	:	SUITE 16
City	:	CHILLICOTHEE
State	:	MO
Zip	:	64601-1676
Country	:	US
Telephone Number	:	660-646-4345
Fax Number	:	660-646-6024

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CAL W GREENLAW
Credential	:	MD
Telephone Number	:	660-646-4345

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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