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NPI Code Detail

MEDICARE: OSU CENTER FOR HEALTH SCIENCES

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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1770127649
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 : 4827 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-3835
Country : US
Telephone Number : 918-561-8306
Fax Number : 918-561-5747
Authorized Official
Title or Position : VICE PRESIDENT FOR ADMIN/FINANCE
Name : ERIC JOHN POLAK
Credential :
Telephone Number : 918-561-8422
Provider Enumeration Date : 11/04/2019
Last Update Date : 11/04/2019

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Directions to “OSU CENTER FOR HEALTH SCIENCES ” Practice Location

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