Provider Demographics
NPI:1104546761
Name:ROY GREENWAY JR MD PLLC
Entity type:Organization
Organization Name:ROY GREENWAY JR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:405-204-5430
Mailing Address - Street 1:922 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3606
Mailing Address - Country:US
Mailing Address - Phone:405-204-5430
Mailing Address - Fax:580-225-2518
Practice Address - Street 1:401 SW 80TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8123
Practice Address - Country:US
Practice Address - Phone:405-601-5169
Practice Address - Fax:405-601-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200196600AMedicaid