Organization
GREEN COUNTRY MEDICAL EQUIPMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL JOSEPH GRIMES CPED (PEDORTHIST)
(918) 855-1813
Entity
Organization
Contact information
Practice address
6112 E 61ST ST, TULSA, OK 74136-2117
(918) 477-7272
(918) 272-0071
Mailing address
6112 E 61ST ST, TULSA, OK 74136-2117
(918) 477-7272
(918) 272-0071
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609019660
BLUE CROSS AND BLUE SHIELD
OK
05
—
200277210A
—
OK
Enumeration date
04/07/2009
Last updated
10/11/2010
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