Provider Demographics
NPI:1497974984
Name:GREEN COUNTRY HEALTHCARE FOR WOMEN
Entity Type:Organization
Organization Name:GREEN COUNTRY HEALTHCARE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONCHITA
Authorized Official - Middle Name:LUSALYER
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-382-5399
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:500
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4000
Mailing Address - Country:US
Mailing Address - Phone:918-382-5399
Mailing Address - Fax:918-382-5704
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:918-382-5399
Practice Address - Fax:918-382-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK207V00000XOtherTAXOMONY
OK2372057OtherPROVIDER NUMBER-UNITED HC
OK261QM2500XOtherTAXONOMY NUMBER
OK2250926OtherUNITED HEALTH CARE
OK593884499004OtherBCBS
OK1720151707OtherNPI -INDIVIUAL
OK261QM2500XOtherTAXONOMY NUMBER
OK207V00000XOtherTAXOMONY