Provider Demographics
NPI:1124557426
Name:STATE OF OKLAHOMA - OSU CENTER FOR HEALTH SCIENCE COLLEGE OF OSTEOPATH
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA - OSU CENTER FOR HEALTH SCIENCE COLLEGE OF OSTEOPATH
Other - Org Name:OSU PHYSICIANS - BEHAVIORAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR ADMINISTRATION & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-561-8422
Mailing Address - Street 1:2345 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-2705
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:2488 E 81ST ST STE 3700
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4290
Practice Address - Country:US
Practice Address - Phone:918-236-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA - OSU CENTER FOR HEALTH SCIENCE COLLEGE OF OSTEOPATH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty