Organization
BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA -OU EMERSON TEEN CLINIC
Active
Other names
OU Emerson Teen Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN MADDY (CHIEF EXECUTIVE OFFICER)
(405) 271-1515
Entity
Organization
Contact information
Practice address
720 N DEWEY AVE, OKLAHOMA CITY, OK 73102-1214
(405) 236-8172
Mailing address
1122 NE 13TH ST, ORI 236, OKLAHOMA CITY, OK 73117-1039
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744720N
—
OK
Enumeration date
04/19/2007
Last updated
09/28/2009
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