Provider Demographics
NPI:1891992251
Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
Entity Type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OU PHYSICIANS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-3932
Mailing Address - Street 1:4502 E 41ST ST # 2G08
Mailing Address - Street 2:OU PHYSICIANS TULSA-OFFICE OF CLINICAL SERVICES
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2553
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:1111 SOUTH ST. LOUIS AVE, STE 2000
Practice Address - Street 2:OU PHYSICIANS TULSA FAM MED WOMEN'S HEALTH SERVICES
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120
Practice Address - Country:US
Practice Address - Phone:918-619-4600
Practice Address - Fax:918-660-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty