| NPI | 1689989238 |
|---|---|
| Doing Business As | THE CLINIC AT GREENTREE |
| Entity Type | Organization |
| Authorized Contact | JACK KIM WILLIS Managing Member 432-218-7862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA05950) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX e7559) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA03268) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 623501) | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2011-09-28 |