NPIMap

Organization Active NPI

Green Country Medical, Inc.

Doing business as Green Country Medical Clinic

  • Clinical Medical Laboratory
  • South Coffeyville, OK
National Provider Identifier
1265658322
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
GREEN COUNTRY MEDICAL, INC.
Doing business as
Green Country Medical Clinic
Practice address
228 Willow
South Coffeyville, OK 74072
Phone
(918) 255-6000
NPI assigned
Apr 17, 2007
Last updated
Oct 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sheryl NeelyNPI 1952641045
Title
RN
Phone
(918) 273-0140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

228 Willow
South Coffeyville, OK 74072

Mailing address

228 Willow
South Coffeyville, OK 74072

Other names 1

  • Green Country Medical Clinic Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0949388Green Country Medical Clinic228 Willow Street, South Coffeyville, OK 74072Certificate of waiverJul 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Green Country Medical Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1265658322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 WILLOW",
            "city": "SOUTH COFFEYVILLE",
            "state": "OK",
            "postal_code": "74072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 WILLOW",
            "city": "SOUTH COFFEYVILLE",
            "state": "OK",
            "postal_code": "74072",
            "telephone_number": "918-255-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN COUNTRY MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "NEELY",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "RN",
        "authorized_official_telephone_number": "918-273-0140"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Country Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Coffeyville, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.