| Green Country Infectious Disease Pc | |
|
421 Stone Wood Dr Broken Arrow OK 74012-1026 | |
| (918) 872-8822 | |
| Not Available |
| Full Name | Green Country Infectious Disease Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 421 Stone Wood Dr, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Janice L Bracken (CREDENTIALING) |
| Authorized Official Contact | 9184486160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Country Infectious Disease Pc 5908 S 298th East Ave Broken Arrow OK 74014-8405 Ph: (918) 872-8822 | Green Country Infectious Disease Pc 421 Stone Wood Dr Broken Arrow OK 74012-1026 Ph: (918) 872-8822 |
| NPI Number | 1639639321 |
|---|---|
| Provider Enumeration Date | 03/20/2019 |
| Last Update Date | 04/03/2019 |
| Medicare PECOS PAC ID | 2062801145 |
|---|---|
| Medicare Enrollment ID | O20211110002718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639639321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Faisal Wasi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689672263 PECOS PAC ID: 1557330412 Enrollment ID: I20040928000317 |
| Provider Name | Cheryl L Sauvie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518346626 PECOS PAC ID: 7911217070 Enrollment ID: I20151103000257 |
| Provider Name | Chandler May White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578261939 PECOS PAC ID: 4880067081 Enrollment ID: I20230309001666 |
| Provider Name | Winter Rose Carson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447031596 PECOS PAC ID: 2365984093 Enrollment ID: I20240610000319 |
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