Organization
OKLAHOMA STATE UNIVERSITY
Active
Other names
OSU Physicians Clinical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JOHN POLAK (VP)
(918) 561-8422
Entity
Organization
Contact information
Practice address
1111 W 17TH ST A220, TULSA, OK 74107-1886
(918) 561-1440
(918) 561-1173
Mailing address
5310 E 31ST ST FL 13, TULSA, OK 74135-5018
(918) 561-5701
(918) 561-1173
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200608290C
—
OK
01
—
37D109477
C L I A
—
Enumeration date
05/18/2016
Last updated
02/18/2026
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