Provider Demographics
NPI:1669486973
Name:DRS. GREEN, P.C.
Entity Type:Organization
Organization Name:DRS. GREEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:OSTERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-764-1084
Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 450W
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:423-968-3713
Mailing Address - Fax:423-968-7352
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 450W
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-968-3713
Practice Address - Fax:423-968-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN009980207R00000X
TN011243207R00000X
TN038379207R00000X
TN023958207R00000X
TN034106207RN0300X
TN015559207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3037796Medicaid
TN3151325Medicaid
TN3037795Medicaid
TN4017031Medicaid
TN3033397Medicaid
TN4091342Medicaid
TNA97474Medicare UPIN
TNF84479Medicare UPIN
TN3896190Medicare ID - Type UnspecifiedDR. JEAN M. MANCINI
TN4017031Medicaid
TN3151325Medicaid
TN3037795Medicaid
TNI15651Medicare UPIN
TNF73307Medicare UPIN
TN3857102Medicare ID - Type UnspecifiedDR. ELVIRA LORIA
TN4091342Medicaid
TN3174372Medicare ID - Type UnspecifiedDR, JOHN A. GREEN
TN3104412Medicare ID - Type UnspecifiedDR. THOMAS W. GREEN, JR.