Organization
OSU CENTER FOR HEALTH SCIENCES
Active
Other names
OSU-AJ MADILL FAMILY MEDICINE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC POLAK (VICE PRESIDENT FOR ADMIN/FINANCE)
(918) 561-8422
Entity
Organization
Contact information
Practice address
207 E TALIAFERRO ST, MADILL, OK 73446-3410
(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
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200069200I
—
OK
Enumeration date
11/20/2006
Last updated
03/24/2016
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