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General NPI Number Information
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NPI Number | 1427632942
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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 | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 3420 S 74TH ST STE 116
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City | FORT SMITH
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State | AR
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Zip | 72903-5026
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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 BLVD
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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 | VICE PRESIDENT FOR OF ADMIN/FINANCE
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Name | ERIC JOHN 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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