Organization
GREEN COUNTRY FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUS D CANADAY JR. ARNP (PRESIDENT/OWNER)
(918) 437-2500
Entity
Organization
Contact information
Practice address
1312 S GARNETT RD, STE E, TULSA, OK 74128-1835
(918) 437-2500
(918) 437-2535
Mailing address
1312 S GARNETT RD, STE. E, TULSA, OK 74128-1835
(918) 437-2500
(918) 437-2535
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0067546
OK
Other
Enumeration date
06/10/2006
Last updated
06/15/2010
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