1275730632 NPI number — BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA

Table of content: (NPI 1275730632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275730632 NPI number — BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA
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:
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:
1275730632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4502 E 41ST ST # 2G08
Provider Second Line Business Mailing Address:
OU PHYSICIANS TULSA-CLINICAL SERVICES
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-660-3232
Provider Business Mailing Address Fax Number:
918-660-3631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OU PHYSICIANS TULSA FAMILY MEDICINE DME
Provider Second Line Business Practice Location Address:
1111 SOUTH ST. LOUIS AVE.
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-660-3614
Provider Business Practice Location Address Fax Number:
908-660-3631
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADDY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO OU PHYSICIANS
Authorized Official Telephone Number:
405-271-3932

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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