MEDICARE: DAVID J. GREENWAY

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1578724654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J. GREENWAY

Provider Business Mailing Address
First Line	:	1100 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2934
Country	:	US
Telephone Number	:	817-335-1411
Fax Number	:	817-335-1466

Provider Business Practice Location Address
First Line	:	1100 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2934
Country	:	US
Telephone Number	:	817-335-1411
Fax Number	:	817-335-1466

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID J GREENWAY
Credential	:	ORTHOTIST
Telephone Number	:	817-335-1411

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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Directions to “DAVID J. GREENWAY ” Practice Location

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