Healthcare Provider Details

I. General information

NPI: 1740403633
Provider Name (Legal Business Name): OKLAHOMA HEALTH SCIENCE CENTER DEPT OF PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EVERETT DRIVE 7TH FLOOR NORTH PAVILION
OKLAHOMA CITY OK
73104-5047
US

IV. Provider business mailing address

1200 EVERETT DRIVE 7TH FLOOR NORTH PAVILION
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5215
  • Fax: 405-271-1236
Mailing address:
  • Phone: 405-271-5215
  • Fax: 405-271-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberR0075677
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR0075677
License Number StateOK

VIII. Authorized Official

Name: KRISHNAMURTHY CHANDRA SEKAR
Title or Position: MEDICAL DIRECTOR NICU OUHSC CHILDRE
Credential: MD
Phone: 405-271-5215