| Green Sports Medicine, Inc. | |
|
2021 Herndon Ave Ste 201 Clovis CA 93611-6101 | |
| (559) 981-5566 | |
| (559) 228-9989 |
| Full Name | Green Sports Medicine, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2021 Herndon Ave Ste 201, Clovis, California |
| Authorized Official Name and Position | Erick Green (MD) |
| Authorized Official Contact | 5598133005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Sports Medicine, Inc. 7471 N Fresno St Fresno CA 93720-2457 Ph: (559) 981-5566 | Green Sports Medicine, Inc. 2021 Herndon Ave Ste 201 Clovis CA 93611-6101 Ph: (559) 981-5566 |
| NPI Number | 1396210563 |
|---|---|
| Provider Enumeration Date | 10/03/2018 |
| Last Update Date | 11/18/2019 |
| Medicare PECOS PAC ID | 2264764919 |
|---|---|
| Medicare Enrollment ID | O20191029002668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396210563 | NPI | - | NPPES |
| Provider Name | Erick J Green |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1821371022 PECOS PAC ID: 4385816289 Enrollment ID: I20140724000820 |
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