1891968780 NPI number — OSU-TULSA SPEECH-LANGUAGE-HEARING CLINIC

Table of content: (NPI 1891968780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891968780 NPI number — OSU-TULSA SPEECH-LANGUAGE-HEARING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSU-TULSA SPEECH-LANGUAGE-HEARING CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OKLAHOMA STATE UNIVERSITY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891968780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HANNER HALL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STILLWATER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74078-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-744-6021
Provider Business Mailing Address Fax Number:
405-744-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 N GREENWOOD AVE
Provider Second Line Business Practice Location Address:
MAIN HALL 1107
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74106-0702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-594-8573
Provider Business Practice Location Address Fax Number:
918-594-8113
Provider Enumeration Date:
04/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FISCHER
Authorized Official First Name:
ALECIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CLINIC COORDINATOR
Authorized Official Telephone Number:
918-594-8573

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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