Provider Demographics
NPI:1316011448
Name:OSU CENTER FOR HEALTH SCIENCES
Entity Type:Organization
Organization Name:OSU CENTER FOR HEALTH SCIENCES
Other - Org Name:OSU-AJ EAR NOSE AND THROAT SPECIALISTS OF TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FOR ADMIN/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:918-561-8306
Mailing Address - Fax:918-561-5747
Practice Address - Street 1:6802 S OLYMPIA AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-561-8306
Practice Address - Fax:918-561-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100757080UMedicaid