Organization
OSU MC PROFESSIONAL SERVICES LLC
Active
Other names
OSU MEDICAL GROUP RIVERSIDE PRIMARY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC POLAK (CFO)
(918) 561-8422
Entity
Organization
Contact information
Practice address
9645 RIVERSIDE PKWY, SUITE C, TULSA, OK 74137-7423
(918) 561-8306
Mailing address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 561-8306
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
11/02/2013
Last updated
11/02/2013
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