Provider Demographics
NPI:1821121930
Name:OKLAHOMA CHRISTIAN UNIVERSITY
Entity Type:Organization
Organization Name:OKLAHOMA CHRISTIAN UNIVERSITY
Other - Org Name:HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-425-5180
Mailing Address - Street 1:2501 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5525
Mailing Address - Country:US
Mailing Address - Phone:405-425-5250
Mailing Address - Fax:405-425-5251
Practice Address - Street 1:2501 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5525
Practice Address - Country:US
Practice Address - Phone:405-425-5250
Practice Address - Fax:405-425-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center