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NPI Code Detail

MEDICARE: GREEN COUNTRY ANESTHESIOLOGY ASSOCIATES, P.C.

MEDICARE: GREEN COUNTRY ANESTHESIOLOGY ASSOCIATES, P.C.
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
1207L00000XAnesthesiology Physician2400OK

General Provider Information

NPI Number : 1235121930
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN COUNTRY ANESTHESIOLOGY ASSOCIATES, P.C.
Provider Business Mailing Address
First Line : DEPT. 1320
Second Line :
City : TULSA
State : OK
Zip : 74182-0001
Country : US
Telephone Number : 918-478-5517
Fax Number : 918-478-5519
Provider Business Practice Location Address
First Line : 300 ROCKEFELLER DR
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-5075
Country : US
Telephone Number : 918-478-5517
Fax Number : 918-478-5519
Authorized Official
Title or Position : OWNER
Name : DR. RONALD S. STEVENS
Credential : D.O.
Telephone Number : 918-478-5517
Provider Enumeration Date : 08/18/2005
Last Update Date : 08/22/2020

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