# OKLAHOMA STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OKLAHOMA STATE UNIVERSITY
- **Other names:** OSU PHYSICIANS, OSU Addiction Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780321893
- **Legal business name:** OKLAHOMA STATE UNIVERSITY
- **Authorized official:** ERIC JOHN POLAK (VP ADMINISTRATIVE AFFAIRS)
- **Authorized official phone:** (918) 561-8422

## Contact information

- **Practice address:** 5310 E 31ST ST STE 1102, TULSA, OK 74135-5018
- **Practice address phone:** (918) 561-1890
- **Practice address fax:** (918) 561-1889
- **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 |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/19/2022
- **Last updated:** 10/28/2024