1205901097 NPI number — OSU CENTER FOR HEALTH SCIENCES

Table of content: (NPI 1205901097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205901097 NPI number — OSU CENTER FOR HEALTH SCIENCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSU CENTER FOR HEALTH SCIENCES
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:
1205901097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2345 SOUTHWEST BLVD
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:
74107-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-561-8306
Provider Business Mailing Address Fax Number:
918-561-5747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6151 S YALE AVE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-561-8306
Provider Business Practice Location Address Fax Number:
918-561-5747
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLAK
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FOR ADMIN/FINANCE
Authorized Official Telephone Number:
918-561-8422

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100757080O , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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