Provider Demographics
NPI:1770851115
Name:OKLAHOMA MEDICAL RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:OKLAHOMA MEDICAL RESEARCH FOUNDATION
Other - Org Name:OMRF CLINICAL PHARMACOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-7452
Mailing Address - Street 1:825 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5005
Mailing Address - Country:US
Mailing Address - Phone:405-271-7805
Mailing Address - Fax:405-271-4110
Practice Address - Street 1:825 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5005
Practice Address - Country:US
Practice Address - Phone:405-271-7805
Practice Address - Fax:405-271-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical PharmacologyGroup - Single Specialty