Provider Demographics
NPI:1003606682
Name:FOOT AND ANKLE SPECIALISTS OF GREEN COUNTRY
Entity type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF GREEN COUNTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-852-2642
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-0334
Mailing Address - Country:US
Mailing Address - Phone:918-852-2642
Mailing Address - Fax:
Practice Address - Street 1:11348 251ST ST
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421-2354
Practice Address - Country:US
Practice Address - Phone:918-852-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty