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
1	251S00000X	Community/Behavioral Health Agency	920	OK
2	251S00000X	Community/Behavioral Health Agency	872	OK

General Provider Information

NPI Number	:	1679872535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	233 HES
Second Line	:	OKLAHOMA STATE UNIVERSITY
City	:	STILLWATER
State	:	OK
Zip	:	74078-6122
Country	:	US
Telephone Number	:	405-744-5058
Fax Number	:	405-744-2800

Provider Business Practice Location Address
First Line	:	101 HES-WEST
Second Line	:	OKLAHOMA STATE UNIVERSITY
City	:	STILLWATER
State	:	OK
Zip	:	74078-6122
Country	:	US
Telephone Number	:	405-744-5058
Fax Number	:	405-744-2800

Authorized Official
Title or Position	:	DEAN, COLLEGE OF HES
Name	:	DR. STEPHAN M. WILSON
Credential	:	PH.D.
Telephone Number	:	405-744-9805

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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Directions to “OKLAHOMA STATE UNIVERSITY ” Practice Location

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