Organization
GREEN COUNTRY MEDICAL, INC
Active
Other names
Green Country Rural Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LACEE HAYES (RN)
(918) 273-0140
Entity
Organization
Contact information
Practice address
228 WILLOW, SOUTH COFFEYVILLE, OK 74072
(918) 255-6000
Mailing address
712 E OSAGE AVE, NOWATA, OK 74048-3638
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100739790F
—
OK
Enumeration date
04/11/2007
Last updated
07/10/2008
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