Provider Demographics
NPI:1679996656
Name:OSU CENTER FOR HEALTH SCIENCES
Entity type:Organization
Organization Name:OSU CENTER FOR HEALTH SCIENCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM VICE PRESIDENT FOR ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMPE
Authorized Official - Phone:918-561-8422
Mailing Address - Street 1:2345 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-2705
Mailing Address - Country:US
Mailing Address - Phone:918-561-8306
Mailing Address - Fax:918-561-5747
Practice Address - Street 1:700 N. GREENWOOD
Practice Address - Street 2:#265NH
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-0702
Practice Address - Country:US
Practice Address - Phone:918-594-8920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center