MEDICARE: MR. JOSHUA HUNTER GREENE OPA-C, LSA

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	2255A2300X	Athletic Trainer	AT001313	GA
2	363AS0400X	Surgical Physician Assistant
3	246ZS0410X	Surgical Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1077	OTHER	TX	STATE LICENSE
2	SA00536	OTHER	TX	TEXAS STATE SURGICAL ASSISTANT LICENSE

General Provider Information

NPI Number	:	1932319803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA HUNTER GREENE OPA-C, LSA

Provider Business Mailing Address
First Line	:	4803 ARROWHEAD LAKE DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6545
Country	:	US
Telephone Number	:	903-826-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 ARROWHEAD LAKE DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6545
Country	:	US
Telephone Number	:	903-826-3302
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/29/2015

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