Provider Demographics
NPI:1255107017
Name:OSU CENTER FOR HEALTH SCIENCES
Entity type:Organization
Organization Name:OSU CENTER FOR HEALTH SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF ADMIN/FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:POLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-561-8422
Mailing Address - Street 1:700 N GREENWOOD AVE
Mailing Address - Street 2:NORTH HALL RM. 372
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-0702
Mailing Address - Country:US
Mailing Address - Phone:918-561-8306
Mailing Address - Fax:918-280-1917
Practice Address - Street 1:1401 W PAWNEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-3033
Practice Address - Country:US
Practice Address - Phone:918-561-8306
Practice Address - Fax:918-280-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center