MEDICARE: GREEN RING 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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1528665957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN RING LLC

Provider Business Mailing Address
First Line	:	16131 N ELDRIDGE PKWY STE 200
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77377-9130
Country	:	US
Telephone Number	:	281-970-5900
Fax Number	:	281-970-5914

Provider Business Practice Location Address
First Line	:	7611 STATE LINE RD STE 130
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1696
Country	:	US
Telephone Number	:	281-970-5900
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAN KLOSTER
Credential	:	MD
Telephone Number	:	281-970-5900

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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Directions to “GREEN RING LLC ” Practice Location

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