| |
712 E Osage Ave Nowata OK 74048-3638 | |
(918) 273-0140 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 712 E Osage Ave, Nowata, Oklahoma |
Authorized Official Name and Position | Lacee Hayes (BILLING) |
Authorized Official Contact | 9182730140 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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712 E Osage Ave Nowata OK 74048-3638 Ph: () - | 712 E Osage Ave Nowata OK 74048-3638 Ph: (918) 273-0140 |
NPI Number | 1497978753 |
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Provider Enumeration Date | 04/11/2007 |
Last Update Date | 07/16/2009 |
Medicare PECOS PAC ID | 2668508615 |
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Medicare Enrollment ID | O20100329000896 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497978753 | NPI | - | NPPES |
100739790A | Other | OK | NOWATA AM X-OVERS |
100739790G | Medicaid | OK | |
100739790B | Other | OK | SCV AM X-OVERS |
100739790H | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Green Country Medical, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 712 E Osage Ave, Nowata, OK 74048 Phone: 918-273-0140 Fax: 918-273-0147 | |