=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558197400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSU CENTER FOR HEALTH SCIENCES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2024
-----------------------------------------------------
Last Update Date | 09/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2116 W IOWA AVE
-----------------------------------------------------
City | CHICKASHA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73018-2736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-561-8306
-----------------------------------------------------
Fax | 918-561-5747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 N GREENWOOD AVE RM 372
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74106-0702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-561-8306
-----------------------------------------------------
Fax | 918-561-5747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PATRICIA KATHLEEN WINDLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-561-8306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------