MEDICARE: SHIRLEY N GREEN BC-IHS, ACA

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	237600000X	Audiologist-Hearing Aid Fitter	50071	TX

General Provider Information

NPI Number	:	1912085895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY N GREEN BC-IHS, ACA

Provider Business Mailing Address
First Line	:	1121 DALLAS DR
Second Line	:	STE 6
City	:	DENTON
State	:	TX
Zip	:	76205-5100
Country	:	US
Telephone Number	:	940-387-2195
Fax Number	:	940-565-5973

Provider Business Practice Location Address
First Line	:	1121 DALLAS DR
Second Line	:	STE 6
City	:	DENTON
State	:	TX
Zip	:	76205-5100
Country	:	US
Telephone Number	:	940-387-2195
Fax Number	:	940-565-5973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/24/2008

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