MEDICARE: OKLAHOMA SLEEP INSTITUTE CLINIC OKC LLC OSI CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	50603	OK

General Provider Information

NPI Number	:	1043454622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA SLEEP INSTITUTE CLINIC OKC LLC OSI CLINIC

Provider Business Mailing Address
First Line	:	14000 N. PORTLAND AVENUE
Second Line	:	SUITE 201
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-4004
Country	:	US
Telephone Number	:	405-606-2727
Fax Number	:	405-606-7040

Provider Business Practice Location Address
First Line	:	14000 N. PORTLAND AVENUE
Second Line	:	SUITE 201A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-4004
Country	:	US
Telephone Number	:	405-606-2727
Fax Number	:	405-606-7040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL C. GOLD
Credential	:
Telephone Number	:	405-606-2727

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	12/20/2011

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