Provider Demographics
NPI:1316188444
Name:INSURANCE SERVICES GREEN, CO.
Entity Type:Organization
Organization Name:INSURANCE SERVICES GREEN, CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-353-4634
Mailing Address - Street 1:1200 SMITH ST
Mailing Address - Street 2:STE 1600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-4313
Mailing Address - Country:US
Mailing Address - Phone:713-353-4634
Mailing Address - Fax:
Practice Address - Street 1:1200 SMITH ST
Practice Address - Street 2:STE 1600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-4313
Practice Address - Country:US
Practice Address - Phone:713-353-4634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04322567261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service