Green Medical Clinic | |
23507 East Riverview Drive Cookson OK 74427 | |
(918) 456-8989 | |
(918) 456-7989 |
Full Name | Green Medical Clinic |
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Speciality | Family Medicine |
Location | 23507 East Riverview Drive, Cookson, Oklahoma |
Authorized Official Name and Position | Lawrence Charles Green (OWNER) |
Authorized Official Contact | 9184568989 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Green Medical Clinic 1 Plaza South St Tahlequah OK 74464-4750 Ph: (918) 456-8989 | Green Medical Clinic 23507 East Riverview Drive Cookson OK 74427 Ph: (918) 456-8989 |
NPI Number | 1801086715 |
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Provider Enumeration Date | 07/26/2007 |
Last Update Date | 11/01/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801086715 | NPI | - | NPPES |
D05217 | Other | OK | UPIN |
100093200D | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 9260 (Oklahoma) | Primary |