Provider Demographics
NPI:1134501661
Name:GREEN COUNTRY HOSPITALISTS, PC
Entity Type:Organization
Organization Name:GREEN COUNTRY HOSPITALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-719-4521
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74402-0627
Mailing Address - Country:US
Mailing Address - Phone:479-719-4521
Mailing Address - Fax:
Practice Address - Street 1:905 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1611
Practice Address - Country:US
Practice Address - Phone:918-967-0072
Practice Address - Fax:918-967-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty