MEDICARE: OSU CENTER FOR HEALTH SCIENCES

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1306911920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSU CENTER FOR HEALTH SCIENCES

Provider Business Mailing Address
First Line	:	2345 SOUTHWEST BLVD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-2705
Country	:	US
Telephone Number	:	918-561-8306
Fax Number	:	918-561-5747

Provider Business Practice Location Address
First Line	:	6201 N SANTA FE AVE
Second Line	:	SUITE 2010
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7538
Country	:	US
Telephone Number	:	918-561-8306
Fax Number	:	918-561-5747

Authorized Official
Title or Position	:	VICE PRESIDENT FOR ADMIN/FINANCE
Name	:	ERIC POLAK
Credential	:
Telephone Number	:	918-561-8422

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/28/2016

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