Provider Demographics
NPI:1932526001
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:OUCP ORTHOPEDIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
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 1:1122 NE 13TH ST
Mailing Address - Street 2:ORI 274
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 1:1200 CHILDRENS AVE
Practice Address - Street 2:OUCP 3100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-2669
Practice Address - Fax:405-271-5313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA-OU PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-26
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1173440011Medicare NSC