Organization
GREEN COUNTRY HEALTHCARE FOR WOMEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONCHITA LUSALYER WOODRUFF M.D. (OWNER)
(918) 382-5399
Entity
Organization
Contact information
Practice address
1145 S UTICA AVE, 500, TULSA, OK 74104-4000
(918) 382-5399
(918) 382-5704
Mailing address
1145 S UTICA AVE, 500, TULSA, OK 74104-4000
(918) 382-5399
(918) 382-5704
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23123
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720151707
NPI -INDIVIUAL
OK
01
—
207V00000X
TAXOMONY
OK
01
—
2250926
UNITED HEALTH CARE
OK
01
—
2372057
PROVIDER NUMBER-UNITED HC
OK
01
—
261QM2500X
TAXONOMY NUMBER
OK
01
—
593884499004
BCBS
OK
Enumeration date
04/24/2007
Last updated
08/22/2020
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