# OSUMC PROFESSIONAL SERVICES LLC

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

## Provider details

- **NPI number:** 1730793696
- **Legal business name:** OSUMC PROFESSIONAL SERVICES LLC
- **Authorized official:** SAMANTHA KAY OVERFIELD (CREDENTIALING ADMINISTRATOR)
- **Authorized official phone:** (918) 561-5714

## Contact information

- **Practice address:** 112 W 5TH STREET, OKMULGEE, OK 74447-0000
- **Practice address phone:** (918) 752-1080
- **Practice address fax:** (918) 752-1081
- **Mailing address:** 2401 SOUTHWEST BLVD, TULSA, OK 74107-2726
- **Mailing address phone:** (918) 561-5701
- **Mailing address fax:** (918) 561-1173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/08/2020
- **Last updated:** 09/08/2020