# OSUMC PROFESSIONAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OSUMC PROFESSIONAL SERVICES LLC
- **Other names:** OSU Medical Group Sand Springs Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1154845501
- **Legal business name:** OSUMC PROFESSIONAL SERVICES LLC
- **Authorized official:** SAMANTHA OVERFIELD (CREDENTIALING ADMINISTRATOR)
- **Authorized official phone:** (918) 561-5714

## Contact information

- **Practice address:** 514 PLAZA CT, SAND SPRINGS, OK 74063-7915
- **Practice address phone:** (918) 215-5100
- **Practice address fax:** (918) 215-5105
- **Mailing address:** 514 PLAZA CT, SAND SPRINGS, OK 74063-7915
- **Mailing address phone:** (918) 215-5100
- **Mailing address fax:** (918) 215-5105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 5451 | OK | Yes |

## Other

- **Enumeration date:** 07/27/2017
- **Last updated:** 07/21/2022