| Green Medical Clinic | |
|
23507 East Riverview Drive Cookson OK 74427 | |
| (918) 456-8989 | |
| (918) 456-7989 |
| Full Name | Green Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 23507 East Riverview Drive, Cookson, Oklahoma |
| Authorized Official Name and Position | Lawrence Charles Green (OWNER) |
| Authorized Official Contact | 9184568989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Medical Clinic 1 Plaza South St Tahlequah OK 74464-4750 Ph: (918) 456-8989 | Green Medical Clinic 23507 East Riverview Drive Cookson OK 74427 Ph: (918) 456-8989 |
| NPI Number | 1801086715 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 11/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801086715 | NPI | - | NPPES |
| D05217 | Other | OK | UPIN |
| 100093200D | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 9260 (Oklahoma) | Primary |