GREEN'S COUNTRY CLINIC, LLC
NPI 1093240749
Physician Assistant - Medical in Blackwell, OK

Q: What is Green's Country Clinic, LLC's NPI number?

The NPI number for Green's Country Clinic, LLC is 1093240749. It was assigned to this organization in the NPPES registry on May 1, 2017.

Q: What is Green's Country Clinic, LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Active since May 01, 2017CLIA 37D2131122 · Waiver

223 E BLACKWELL AVE, BLACKWELL, OK 74631(580) 363-0943 Get Directions Write a Review

NPPES record last updated: May 1, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Green's Country Clinic, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREEN'S COUNTRY CLINIC, LLC (NPI 1093240749) is a healthcare organization registered as a medical in Blackwell, Oklahoma and active in the NPI registry since May 2017. The organization holds a CLIA Waiver certificate valid through May 22, 2027 and lists Phil Green, Physician Assistant, as its authorized official.

NPPES Registry Identity

NPI1093240749

Entity TypeOrganization

Primary Taxonomy363AM0700X

Legal Business NameGREEN'S COUNTRY CLINIC, LLC

Location Address223 E BLACKWELL AVEBlackwell, OK 74631-2909

Mailing Address223 E Blackwell AveBlackwell, OK 74631-2909

Phone(580) 363-0943

Organization SubpartNo

Authorized OfficialPhil GreenPhysician Assistant · (580) 363-0943

Enumeration DateMay 1, 2017

✔ NPI 1093240749 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in OK · 800

223 E BLACKWELL AVE, Blackwell, OK 74631

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D2131122

Green's Country Clinic · Blackwell, OK

Active · expires May 22, 2027

CLIA Number37D2131122

Laboratory TypePhysician Office

Certificate Effective DateMay 23, 2025

Certificate Expiration DateMay 22, 2027

Laboratory DirectorPhil J. Green Pa-C

Laboratory Phone(580) 363-0943

Laboratory LocationGreen's Country Clinic223 E Blackwell Ave, Blackwell, OK 74631

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Green's Country Clinic, LLC's NPI number?

The NPI number for Green's Country Clinic, LLC is 1093240749. It was assigned to this organization in the NPPES registry on May 1, 2017.

Where is Green's Country Clinic, LLC located?

Green's Country Clinic, LLC is located at 223 E Blackwell Ave, Blackwell, OK 74631. The listed phone number is (580) 363-0943.

What is Green's Country Clinic, LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Does Green's Country Clinic, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D2131122) is associated with this NPI, valid through May 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Green's Country Clinic, LLC was last updated on May 1, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.