Healthcare Provider Details

I. General information

NPI: 1023052735
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KENDALL WHITTIER ELEMENTARY SCHOOL 2601 E 5TH PLACE
TULSA OK
74104
US

IV. Provider business mailing address

OU PHYSICIANS TULSA-CLINICAL SERVICES 4502 E. 41ST STREET, 2G08
TULSA OK
74135-2553
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3614
  • Fax:
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN L MADDY
Title or Position: CEO OU PHYSICIANS
Credential:
Phone: 405-271-3932