Provider Demographics
NPI: | 1629370937 |
---|---|
Name: | OSU-CENTER FOR HEALTH SCIENCES |
Entity Type: | Organization |
Organization Name: | OSU-CENTER FOR HEALTH SCIENCES |
Other - Org Name: | OSU-AJ EMERGENCY SERVICES OF OKLAHOMA PC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO OSU PHYSICIANS |
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: | 4401 S WESTERN AVE |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73109-3413 |
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: | 2010-11-19 |
Last Update Date: | 2016-03-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |