Provider Demographics
NPI:1881639367
Name:OSU UNIVERSITY HEALTH SERVICES
Entity Type:Organization
Organization Name:OSU UNIVERSITY HEALTH SERVICES
Other - Org Name:OSU STUDENT HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNEHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-744-7665
Mailing Address - Street 1:1202 W FARM RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-2000
Mailing Address - Country:US
Mailing Address - Phone:405-744-7665
Mailing Address - Fax:405-744-2059
Practice Address - Street 1:1202 W FARM RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-2000
Practice Address - Country:US
Practice Address - Phone:405-744-7665
Practice Address - Fax:405-744-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherEIN