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Organization
STATE OF OKLAHOMA OSU CENTER FOR HEALTH SCIENCES
Active
Organization
STATE OF OKLAHOMA OSU CENTER FOR HEALTH SCIENCES
Active
Parent organization
OKLAHOMA STATE UNIVERSITY
Other names
OSU Physicians Addiction Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
OKLAHOMA STATE UNIVERSITY
Authorized official
ERIC JOHN POLAK (VP/CFO)
(918) 561-8422
Entity
Organization
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 561-1700
(918) 561-1701
Mailing address
2401 SOUTHWEST BLVD, TULSA, OK 74107-2726
(918) 561-1700
(918) 561-1701
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Enumeration date
05/09/2019
Last updated
05/09/2019
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