# STATE OF OKLAHOMA - OSU CENTER FOR HEALTH SCIENCES COLLEGE OF OSTEOPAT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OSU Country Garden Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881753358
- **Authorized official:** REBECCA WILSON (DIRECTOR OF CLINIC FINANCIAL SERVIC)
- **Authorized official phone:** (918) 561-8322

## Contact information

- **Practice address:** 446 W LATIMER ST, TULSA, OK 74106-5106
- **Practice address phone:** (918) 594-8920
- **Practice address fax:** (918) 594-8926
- **Mailing address:** 2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
- **Mailing address phone:** (918) 561-5701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 06/25/2008

## Other identifiers

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