Organization
STATE OF OKLAHOMA - OSU CENTER FOR HEALTH SCIENCES COLLEGE OF OSTEOPAT
Active
Other names
OSU Country Club Garden Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA WILSON (DIRECTOR OF CLINIC FINANCIAL SERVIC)
(918) 561-8322
Entity
Organization
Contact information
Practice address
446 W LATIMER ST, TULSA, OK 74106-5106
(918) 594-8920
(918) 594-8926
Mailing address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 561-5701
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WCDMB
—
OK
Enumeration date
12/12/2006
Last updated
06/25/2008
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