Organization
BOARD OF REGENTS OF THE UNIV OF OKLAHOMA-OU PHYS EDMOND CLINIC
Active
Other names
OU Physicians Edmond Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN MADDY (CHIEF EXECUTIVE OFFICER)
(405) 271-1515
Entity
Organization
Contact information
Practice address
105 N BRYANT, SUITE 305, EDMOND, OK 73034
(405) 330-8641
Mailing address
1122 NE 13TH ST, ORI236, OKLAHOMA CITY, OK 73117-1039
(405) 271-1515
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1173440010
DME PALMETTO MEDICARE
OK
Enumeration date
09/06/2006
Last updated
10/05/2009
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