Provider Demographics
NPI:1043460694
Name:URGENT CARE OF GREEN COUNTRY PLLC
Entity Type:Organization
Organization Name:URGENT CARE OF GREEN COUNTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-274-8555
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-1044
Mailing Address - Country:US
Mailing Address - Phone:918-343-6000
Mailing Address - Fax:918-343-6251
Practice Address - Street 1:4115 REDDEN
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-9192
Practice Address - Country:US
Practice Address - Phone:918-825-7555
Practice Address - Fax:918-825-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094640FOtherMEDICAID DME
OK7835422OtherAETNA
OK200094640DMedicaid
OK7835422OtherAETNA
OK6282510001Medicare NSC