Provider Demographics
NPI:1982827390
Name:ALLERGY & ASTHMA CLINIC OF GREEN COUNTRY
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CLINIC OF GREEN COUNTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-333-7811
Mailing Address - Street 1:224 SE DEBELL AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2305
Mailing Address - Country:US
Mailing Address - Phone:918-333-7811
Mailing Address - Fax:918-333-4825
Practice Address - Street 1:224 SE DEBELL AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2305
Practice Address - Country:US
Practice Address - Phone:918-333-7811
Practice Address - Fax:918-333-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8877207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100116830AMedicaid
OKOKB5183Medicare PIN
OK100116830AMedicaid