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Organization

GREEN COUNTRY EMERGENCY PHYSICIANS GROUP OF OWASSO PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA WARLICK (CREDENTIALING COORDINATOR)
(918) 664-9892
Entity
Organization

Contact information

Practice address
10502 N 110TH EAST AVE, OWASSO, OK 74055-6655
(918) 376-8000
(918) 664-2521
Mailing address
4500 S GARNETT RD, STE 300, TULSA, OK 74146-5229
(918) 664-9892
(918) 664-2521

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200100660A
OK
Enumeration date
11/01/2006
Last updated
03/12/2010
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