Provider Demographics
NPI:1346784683
Name:OSU CARDIOLOGY
Entity Type:Organization
Organization Name:OSU CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER/LPN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-582-7711
Mailing Address - Street 1:802 S JACKSON AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9015
Mailing Address - Country:US
Mailing Address - Phone:918-582-7711
Mailing Address - Fax:918-583-5831
Practice Address - Street 1:802 S JACKSON AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9015
Practice Address - Country:US
Practice Address - Phone:918-582-7711
Practice Address - Fax:918-583-5831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSU COLLEGE OF OSTEOPATHIC MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4168207RI0011X
OK3798207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty