Basic Information
| Provider Information | |||||||||
| NPI: | 1104546761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROY GREENWAY JR MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 922 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736443606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052045430 | ||||||||
| FaxNumber: | 5802252518 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 SW 80TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731398123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056015169 | ||||||||
| FaxNumber: | 4056019095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2022 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | GREENWAY | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGEON/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4052045430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD, FACS | ||||||||
| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200196600A | 05 | OK | MEDICAID |