Provider Demographics
NPI:1205341757
Name:GREEN, JASON D
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
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 1:275 E VISTA RIDGE MALL DR
Mailing Address - Street 2:6617
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4016
Mailing Address - Country:US
Mailing Address - Phone:313-733-7343
Mailing Address - Fax:
Practice Address - Street 1:275 E VISTA RIDGE MALL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4016
Practice Address - Country:US
Practice Address - Phone:313-733-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)