Healthcare Provider Details

I. General information

NPI: 1609019660
Provider Name (Legal Business Name): GREEN COUNTRY MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 10/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 E 61ST ST
TULSA OK
74136-2117
US

IV. Provider business mailing address

6112 E 61ST ST
TULSA OK
74136-2117
US

V. Phone/Fax

Practice location:
  • Phone: 918-477-7272
  • Fax: 918-272-0071
Mailing address:
  • Phone: 918-477-7272
  • Fax: 918-272-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL JOSEPH GRIMES
Title or Position: PEDORTHIST
Credential: CPED
Phone: 918-855-1813