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General NPI Number Information
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NPI Number | 1831250802
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Entity Type | Organization
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Legal Business Name | OKLAHOMA STATE UNIVERSITY
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 635 W 11TH ST
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City | TULSA
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State | OK
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Zip | 74127-9014
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Country | US
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Telephone | 918-382-3190
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Fax | 918-382-6789
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Provider Business Mailing Address
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Address Line | 5310 E 31ST ST STE 13
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City | TULSA
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State | OK
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Zip | 74135-5013
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Country | US
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Telephone | 918-567-5701
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Fax | 918-561-1173
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Authorized Official
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Title or Position | VP
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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