Organization
OSUMC PROFESSIONAL SERVICES LLC
Active
Parent organization
OSUMC PROFESSIONAL SERVICES LLC
Other names
OSU Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
OSUMC PROFESSIONAL SERVICES LLC
Authorized official
SAMANTHA KAY OVERFIELD (CREDENTIALING ADMINISTRATOR)
(918) 561-5714
Entity
Organization
Contact information
Practice address
112 W 5TH STREET, OKMULGEE, OK 74447-0000
(918) 752-1080
(918) 752-1081
Mailing address
2401 SOUTHWEST BLVD, TULSA, OK 74107-2726
(918) 561-5701
(918) 561-1173
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/08/2020
Last updated
09/08/2020
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