NPIMap

Organization Active NPI

Osu Center for Health Sciences

Doing business as Osu-Aj Family Medical Clinic of Western Oklahoma

  • Medical Specialty Clinic/Center
  • Elk City, OK
National Provider Identifier
1134293236
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
OSU CENTER FOR HEALTH SCIENCES
Doing business as
Osu-Aj Family Medical Clinic of Western Oklahoma
Practice address
411 N Randall Ave
Elk City, OK 73644-4127
Phone
(918) 561-8306
Fax
(918) 561-5747
NPI assigned
Nov 20, 2006
Last updated
Apr 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eric Polak
Title
Vice President for Admin/Finance
Phone
(918) 561-8422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X NU Primary

Addresses

Primary practice location

411 N Randall Ave
Elk City, OK 73644-4127

Mailing address

2345 Southwest Blvd
Tulsa, OK 74107-2705
Phone (918) 561-8306

Other identifiers 1

IdentifierTypeStateIssuer
200091560CMedicaidOK

Other names 1

  • OSU-AJ FAMILY MEDICAL CLINIC OF WESTERN OKLAHOMA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Oklahoma State University221 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1134293236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 SOUTHWEST BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741072705",
            "telephone_number": "918-561-8306",
            "fax_number": "918-561-5747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N RANDALL AVE",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736444127",
            "telephone_number": "918-561-8306",
            "fax_number": "918-561-5747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSU CENTER FOR HEALTH SCIENCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "POLAK",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VICE PRESIDENT FOR ADMIN/FINANCE",
        "authorized_official_telephone_number": "918-561-8422"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200091560C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSU-AJ FAMILY MEDICAL CLINIC OF WESTERN OKLAHOMA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elk City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.