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NPI Code Detail

MEDICARE: TAYLOR MITCHELL GREENHAW

MEDICARE: TAYLOR MITCHELL GREENHAW
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
1363A00000XPhysician Assistant5671OK

General Provider Information

NPI Number : 1215619481
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR MITCHELL GREENHAW
Provider Business Mailing Address
First Line : 6600 S YALE AVE STE 1200
Second Line :
City : TULSA
State : OK
Zip : 74136-3361
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 ROCKEFELLER DR
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-5075
Country : US
Telephone Number : 918-684-2420
Fax Number : 918-502-7573
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2023
Last Update Date : 01/12/2026

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Directions to “ TAYLOR MITCHELL GREENHAW ” Practice Location

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