Provider Demographics
NPI:1609019660
Name:GREEN COUNTRY MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:GREEN COUNTRY MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:918-855-1813
Mailing Address - Street 1:6112 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2117
Mailing Address - Country:US
Mailing Address - Phone:918-477-7272
Mailing Address - Fax:918-272-0071
Practice Address - Street 1:6112 E 61ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2117
Practice Address - Country:US
Practice Address - Phone:918-477-7272
Practice Address - Fax:918-272-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1609019660OtherBLUE CROSS AND BLUE SHIELD
OK200277210AMedicaid
OK1609019660OtherOKLAHOMA DEPARTMENT OF REHABILITATION SERVICES
OK1609019660OtherHEALTHCHOICE
OK1609019660OtherOKLAHOMA DEPARTMENT OF REHABILITATION SERVICES