MEDICARE: STATCARE CLINICS OF GREEN COUNTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1780021576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATCARE CLINICS OF GREEN COUNTRY LLC

Provider Business Mailing Address
First Line	:	9716 RIVERSIDE PKWY
Second Line	:	STE 100
City	:	TULSA
State	:	OK
Zip	:	74137-7447
Country	:	US
Telephone Number	:	918-299-4333
Fax Number	:	918-299-4330

Provider Business Practice Location Address
First Line	:	1217 E 48TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-4701
Country	:	US
Telephone Number	:	918-299-4333
Fax Number	:	918-299-4330

Authorized Official
Title or Position	:	PHYSICIAN/PARTNER
Name	:	BARBARA RYGIEL
Credential	:	D.O.
Telephone Number	:	918-299-4333

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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