Healthcare Provider Details

I. General information

NPI: 1245584416
Provider Name (Legal Business Name): OSU CENTER FOR HEALTH SCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W. MAIN AVE.
CHOUTEAU OK
74337-2842
US

IV. Provider business mailing address

2345 SOUTHWEST BLVD
TULSA OK
74107-2705
US

V. Phone/Fax

Practice location:
  • Phone: 918-561-8306
  • Fax: 918-561-5747
Mailing address:
  • Phone: 918-561-8306
  • Fax: 918-561-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC POLAK
Title or Position: VICE PRESIDENT FOR ADMIN/FINANCE
Credential:
Phone: 918-561-8422