Provider Demographics
NPI:1265632129
Name:OKLAHOMA OCCUPATIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:OKLAHOMA OCCUPATIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:918-622-5669
Mailing Address - Street 1:5640 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9001
Mailing Address - Country:US
Mailing Address - Phone:918-622-5669
Mailing Address - Fax:918-624-2673
Practice Address - Street 1:5640 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9001
Practice Address - Country:US
Practice Address - Phone:918-622-5669
Practice Address - Fax:918-624-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA545OK363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty