GREEN'S COUNTRY CLINIC LLC NPI 1093240749

NPI Information

NPI: 1093240749
Provider Name: GREEN'S COUNTRY CLINIC, LLC
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

CLIA Number: 37D2131122

Address:
223 E BLACKWELL AVE
BLACKWELL, OK
ZIP 74631
Phone: (580) 363-0943
Get Directions

GREEN'S COUNTRY CLINIC, LLC is a medical physician assistant in Blackwell, OK. GREEN'S COUNTRY CLINIC, LLC NPI is 1093240749. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

223 E BLACKWELL AVE
BLACKWELL, OK
ZIP 74631-909
Phone: (580) 363-0943

The provider's authorized official is Phil Green .
The authorized official title is Physician Assistant and has the following contact phone number (580) 363-0943.

The CLIA number assigned to this NPI record is 37D2131122 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/1/2017 and was last updated on 5/1/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	800	OKLAHOMA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »