Provider Demographics
NPI:1205826062
Name:STATE OF OKLAHOMA BOARD OF REGENTS THE UNIV OF OKLA HEALTH SCIENCE CT
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA BOARD OF REGENTS THE UNIV OF OKLA HEALTH SCIENCE CT
Other - Org Name:JOHN W KEYS SPEECH AND HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DEAN FOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:BBA MPH
Authorized Official - Phone:405-271-2288
Mailing Address - Street 1:JOHN W KEYS SPEECH AND HEARING CENTER
Mailing Address - Street 2:1200 N STONEWALL AVE
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1215
Mailing Address - Country:US
Mailing Address - Phone:405-271-4214
Mailing Address - Fax:405-271-3360
Practice Address - Street 1:JOHN W KEYS SPEECH AND HEARING CENTER
Practice Address - Street 2:1200 N STONEWALL AVE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1215
Practice Address - Country:US
Practice Address - Phone:405-271-4214
Practice Address - Fax:405-271-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100628930AMedicaid