Provider Demographics
NPI:1477139962
Name:GREEN, JOSEPH MIREO
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MIREO
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352834
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-2834
Mailing Address - Country:US
Mailing Address - Phone:346-331-3175
Mailing Address - Fax:
Practice Address - Street 1:4431 HILL AVE APT A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5459
Practice Address - Country:US
Practice Address - Phone:346-331-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)