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General NPI Number Information
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NPI Number | 1366791857
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Entity Type | Organization
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Legal Business Name | OSU CENTER FOR HEALTH SCIENCES
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 8803 S. 101ST E. AVE. SUITE 165
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City | TULSA
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State | OK
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Zip | 74133-5750
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Country | US
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Telephone | 918-561-8306
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Fax | 918-561-5747
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Provider Business Mailing Address
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Address Line | 2345 SOUTHWEST BOULEVARD
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City | TULSA
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State | OK
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Zip | 74107-2705
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Country | US
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Telephone | 918-561-8306
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Fax | 918-561-5747
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Authorized Official
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Title or Position | CFO OSU PHYSICIANS
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Name | ERIC POLAK
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Credential |
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Telephone | 918-561-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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