Healthcare Provider Details

I. General information

NPI: 1972608115
Provider Name (Legal Business Name): GREEN COUNTRY PODIATRY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 S HARVARD AVE
TULSA OK
74135-2227
US

IV. Provider business mailing address

3627 S HARVARD AVE
TULSA OK
74135-2227
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-4855
  • Fax: 918-747-4866
Mailing address:
  • Phone: 918-747-4855
  • Fax: 918-747-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. GINGER L FRISBIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-747-4855