Provider Demographics
NPI:1801869250
Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Entity type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZUBIALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-271-1515
Mailing Address - Street 1:1122 NE 13TH ST
Mailing Address - Street 2:ORI274
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1039
Mailing Address - Country:US
Mailing Address - Phone:405-271-1515
Mailing Address - Fax:405-271-1001
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-3932
Practice Address - Fax:405-271-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744720AMedicaid
OK100811290AMedicaid
OK647679OtherMEDICARE DIABETIC PREVENTION PROGRAM
24R600612Medicare PIN
246625501Medicare PIN
OK100811290AMedicaid
OK1173440008Medicare NSC
24R601333Medicare PIN
OK1173440002Medicare NSC
242720811Medicare PIN
24R601887Medicare PIN
OK100744720AMedicaid
OK1173440004Medicare NSC
OK1173440001Medicare NSC
24R601830Medicare PIN
OK1173440005Medicare NSC
OK800522480Medicare PIN
OK4000005Medicare PIN
OK1173440006Medicare NSC
OK1173440003Medicare NSC
24R600665Medicare PIN
249722104Medicare PIN
OK1173440007Medicare NSC
OK1173440010Medicare NSC