Healthcare Provider Details

I. General information

NPI: 1881639367
Provider Name (Legal Business Name): OSU UNIVERSITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 W FARM RD
STILLWATER OK
74078-2000
US

IV. Provider business mailing address

1202 W FARM RD
STILLWATER OK
74078-2000
US

V. Phone/Fax

Practice location:
  • Phone: 405-744-7665
  • Fax: 405-744-2059
Mailing address:
  • Phone: 405-744-7665
  • Fax: 405-744-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JACK HENNEHA
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 405-744-7665