MEDICARE: BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2086S0102X	Surgical Critical Care Physician
2	2086S0122X	Plastic and Reconstructive Surgery Physician
3	2086S0129X	Vascular Surgery Physician
4	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417154048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA

Provider Business Mailing Address
First Line	:	4502 E 41ST ST # 2G08
Second Line	:	OU PHYSICIANS TULSA-CLINICAL SERVICES
City	:	TULSA
State	:	OK
Zip	:	74135-2553
Country	:	US
Telephone Number	:	918-660-3632
Fax Number	:	918-660-3631

Provider Business Practice Location Address
First Line	:	1919 S WHEELING AVE STE 600
Second Line	:	OU PHYSICIANS TULSA SURGICAL SPECIALIST
City	:	TULSA
State	:	OK
Zip	:	74104-5635
Country	:	US
Telephone Number	:	918-634-7500
Fax Number	:	918-634-7560

Authorized Official
Title or Position	:	CEO OU PHYSICIANS
Name	:	MR. BRIAN L MADDY
Credential	:
Telephone Number	:	405-271-3932

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	07/05/2013

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Directions to “BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA ” Practice Location

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