Provider Demographics
NPI:1043454622
Name:OKLAHOMA SLEEP INSTITUTE CLINIC OKC LLC OSI CLINIC
Entity Type:Organization
Organization Name:OKLAHOMA SLEEP INSTITUTE CLINIC OKC LLC OSI CLINIC
Other - Org Name:OSI CLINIC OKC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-606-2727
Mailing Address - Street 1:14000 N. PORTLAND AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4004
Mailing Address - Country:US
Mailing Address - Phone:405-606-2727
Mailing Address - Fax:405-606-7040
Practice Address - Street 1:14000 N. PORTLAND AVENUE
Practice Address - Street 2:SUITE 201A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-4004
Practice Address - Country:US
Practice Address - Phone:405-606-2727
Practice Address - Fax:405-606-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP48721Medicare UPIN