Organization
GREEN'S COUNTRY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHIL GREEN PA-C (PHYSICIAN ASSISTANT)
(580) 363-0943
Entity
Organization
Contact information
Practice address
223 E BLACKWELL AVE, BLACKWELL, OK 74631-2909
(580) 363-0943
Mailing address
223 E BLACKWELL AVE, BLACKWELL, OK 74631-2909
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
800
OK
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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