Provider Demographics
NPI:1669520862
Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA, HEALTH SCIENCES CENTER
Entity type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA, HEALTH SCIENCES CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR RESEARCH ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-271-2090
Mailing Address - Street 1:1000 STANTON L YOUNG BLVD # 121
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1208
Mailing Address - Country:US
Mailing Address - Phone:405-271-2090
Mailing Address - Fax:405-271-8655
Practice Address - Street 1:1201 N STONEWALL AVE RM 265
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-4711
Practice Address - Fax:405-271-2922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA, HEALTH SCIENCES CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-07
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749420AMedicaid