Healthcare Provider Details

I. General information

NPI: 1477488682
Provider Name (Legal Business Name): GREEN COUNTRY BREAST IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 S YALE AVE STE 410
TULSA OK
74136-7817
US

IV. Provider business mailing address

6475 S YALE AVE STE 410
TULSA OK
74136-7817
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID HARRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 316-685-2371