1578704938 NPI number — OKLAHOMA STATE UNIVERSITY MEDICAL TRUST

Table of content: SHAWN JOSEPH DENISTON PHARMD (NPI 1598795437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578704938 NPI number — OKLAHOMA STATE UNIVERSITY MEDICAL TRUST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA STATE UNIVERSITY MEDICAL TRUST
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:
Provider Other Organization Name Type Code:
6
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:
1578704938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
744 W 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74127-9907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-599-1000
Provider Business Mailing Address Fax Number:
918-599-4508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 W 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74127-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-587-2561
Provider Business Practice Location Address Fax Number:
918-599-1750
Provider Enumeration Date:
03/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DUNAWAY
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
918-599-4529

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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