Provider Demographics
NPI:1578724654
Name:DAVID J. GREENWAY
Entity type:Organization
Organization Name:DAVID J. GREENWAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENWAY
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTIST
Authorized Official - Phone:817-335-1411
Mailing Address - Street 1:1100 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2934
Mailing Address - Country:US
Mailing Address - Phone:817-335-1411
Mailing Address - Fax:817-335-1466
Practice Address - Street 1:1100 W CANNON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2934
Practice Address - Country:US
Practice Address - Phone:817-335-1411
Practice Address - Fax:817-335-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0704810001Medicare NSC