Provider Demographics
NPI:1861743692
Name:GREENTREE AUDIOLOGY INC
Entity type:Organization
Organization Name:GREENTREE AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD,CCC-A/FAAA
Authorized Official - Phone:314-835-9996
Mailing Address - Street 1:10900 MANCHESTER RD
Mailing Address - Street 2:STE 202
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1200
Mailing Address - Country:US
Mailing Address - Phone:314-835-9996
Mailing Address - Fax:314-835-9992
Practice Address - Street 1:10900 MANCHESTER RD
Practice Address - Street 2:STE 202
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-1200
Practice Address - Country:US
Practice Address - Phone:314-835-9996
Practice Address - Fax:314-835-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center