Organization
OSU OWASSO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM PENICK (ASSOCIATE DIRECTOR)
(918) 561-8322
Entity
Organization
Contact information
Practice address
10512 N. 110TH E. AVE, OWASSO, OK 74055
(918) 747-5322
Mailing address
10512 N. 110TH E. AVE, OWASSO, OK 74055
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
12/11/2006
Last updated
09/16/2008
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