Country Care Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

COUNTRY CARE CLINIC

Practice address

309 W 2ND St Ste B
Wellston, OK 74881-9496

Phone

(405) 356-3001

Fax

(405) 832-1144

NPI assigned

Feb 6, 2020

Last updated

Feb 6, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tiffany Green

Title

Owner

Phone

(405) 356-3001

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1770115933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "WELLSTON",
            "state": "OK",
            "postal_code": "748810304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 W 2ND ST STE B",
            "city": "WELLSTON",
            "state": "OK",
            "postal_code": "748819496",
            "telephone_number": "405-356-3001",
            "fax_number": "405-832-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-356-3001"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Marie Perdue, LLC
• Jill Maree Bashorun, LPC
• Melanie Blevins
• Courtney Mellisa Butts
• Clinic at Wellston
• Country Care Family Clinic, LLC
• Dedicated Outpatient Therapy Services, LLC (D.O.T.S., LLC)
• Tammy Gore
• Dana Lea Green, MS, CCC-SLP
• Katherine R Dossey (Wellston Clinic Pharmacy)

• Primary Care Clinic/Center in Wellston, OK
• Providers in Wellston, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.