Organization
OSU CENTER FOR HEALTH SCIENCES
Active
Other names
OSU-AJ WARREN CLINIC PEDIATRICS COWETA
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JOHN POLAK (VISE PRESIDENT OF ADMIN AND FINANCE)
(918) 561-8422
Entity
Organization
Contact information
Practice address
30011 E STATE HIGHWAY 51, COWETA, OK 74429-7681
(918) 561-8306
(918) 561-5747
Mailing address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 561-8306
(918) 561-5747
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2020
Last updated
06/28/2023
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