| |
207 S Locust St Nowata OK 74048-3660 | |
(918) 273-9911 | |
(918) 273-9946 |
Full Name | |
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Speciality | Clinic/Center |
Location | 207 S Locust St, Nowata, Oklahoma |
Authorized Official Name and Position | Saunya Moore (CFO) |
Authorized Official Contact | 9182956107 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1334 N Lansing Ave Tulsa OK 74106-5907 Ph: (918) 587-2171 | 207 S Locust St Nowata OK 74048-3660 Ph: (918) 273-9911 |
NPI Number | 1538155163 |
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Provider Enumeration Date | 09/20/2005 |
Last Update Date | 07/24/2019 |
Medicare PECOS PAC ID | 1951297621 |
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Medicare Enrollment ID | O20111213000636 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538155163 | NPI | - | NPPES |
1538155163 | Other | OK | NPI |
100768880J | Medicaid | OK | |
WCDPG | Other | OK | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oklahoma) | 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 | |