Provider Demographics
NPI:1952334658
Name:STATE OF OKLAHOMA
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:UCO STUDENT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLININC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-974-3117
Mailing Address - Street 1:100 N UNIVERSITY DR # 123
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5207
Mailing Address - Country:US
Mailing Address - Phone:405-974-3117
Mailing Address - Fax:405-974-3832
Practice Address - Street 1:100 N UNIVERSITY DR # 105
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5207
Practice Address - Country:US
Practice Address - Phone:405-974-3117
Practice Address - Fax:405-974-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty