# OKLAHOMA STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OSU Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306882261
- **Authorized official:** ERIC JOHN POLAK (VP/CFO)
- **Authorized official phone:** (918) 561-8422

## Contact information

- **Practice address:** 2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
- **Practice address phone:** (918) 561-5701
- **Practice address fax:** (918) 585-9273
- **Mailing address:** 5310 E 31ST ST FL 13, TULSA, OK 74135-5018
- **Mailing address phone:** (918) 561-5701
- **Mailing address fax:** (918) 561-1173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208600000X | Surgery Physician | — | — | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 02/18/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100757080A | — | OK |