Provider Demographics
NPI:1689242505
Name:ED GREEN ELECTRIC INC
Entity Type:Organization
Organization Name:ED GREEN ELECTRIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-385-8624
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0026
Mailing Address - Country:US
Mailing Address - Phone:740-385-8624
Mailing Address - Fax:740-385-0024
Practice Address - Street 1:406 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1654
Practice Address - Country:US
Practice Address - Phone:740-385-8624
Practice Address - Fax:740-385-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24618OtherOHIO DEPARTMENT OF COMMERCE