Provider Demographics
NPI:1740456706
Name:GREENLEY OAKS EAR, NOSE & THROAT, APC
Entity type:Organization
Organization Name:GREENLEY OAKS EAR, NOSE & THROAT, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-533-2545
Mailing Address - Street 1:795 MORNING STAR DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5193
Mailing Address - Country:US
Mailing Address - Phone:209-533-2545
Mailing Address - Fax:209-533-0924
Practice Address - Street 1:795 MORNING STAR DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5193
Practice Address - Country:US
Practice Address - Phone:209-533-2545
Practice Address - Fax:209-533-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G317680Medicaid
CA00G670890Medicaid
CAG35514Medicare UPIN
CA00G317680Medicaid
CA00G317680Medicare PIN
CA00G670890Medicare PIN