Healthcare Provider Details

I. General information

NPI: 1750828893
Provider Name (Legal Business Name): OKLAHOMA STATE UNIVERISTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S HOUSTON AVE SUITE 400
TULSA OK
74127-9023
US

IV. Provider business mailing address

717 S HOUSTON AVE SUITE 400
TULSA OK
74127-9023
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number5986
License Number StateOK

VIII. Authorized Official

Name: DR. SHAWNA DUNCAN
Title or Position: PROGRAM DIRECTOR
Credential: DO
Phone: 918-382-4600