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NPI Code Detail

MEDICARE: OKLAHOMA STATE UNIVERSITY

MEDICARE: OKLAHOMA STATE UNIVERSITY
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
1261QM2500XMedical Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11306882261OTHEROSU GROUP NPI

General Provider Information

NPI Number : 1437480670
Entity Type Code : Organization
Provider Name (Legal Business Name) : OKLAHOMA STATE UNIVERSITY
Provider Business Mailing Address
First Line : 5310 E 31ST ST FL 13
Second Line :
City : TULSA
State : OK
Zip : 74135-5018
Country : US
Telephone Number : 918-561-5701
Fax Number : 918-585-9273
Provider Business Practice Location Address
First Line : 14002 E 21ST ST STE 1130
Second Line :
City : TULSA
State : OK
Zip : 74134-1408
Country : US
Telephone Number : 918-439-1200
Fax Number : 918-439-1199
Authorized Official
Title or Position : VP
Name : ERIC JOHN POLAK
Credential :
Telephone Number : 918-561-8422
Provider Enumeration Date : 01/28/2010
Last Update Date : 02/18/2026

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Directions to “OKLAHOMA STATE UNIVERSITY ” Practice Location

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