NPIMap

Organization Active NPI

Osu Center for Health Sciences

Doing business as Osu-Aj Southside Dermatology Muskogee

  • Clinic/Center
  • Muskogee, OK
National Provider Identifier
1376274118
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
OSU CENTER FOR HEALTH SCIENCES
Doing business as
Osu-Aj Southside Dermatology Muskogee
Practice address
333 S 38TH St Ste E
Muskogee, OK 74401-4937
Phone
(918) 561-8306
Fax
(918) 561-5747
NPI assigned
Jun 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

333 S 38TH St Ste E
Muskogee, OK 74401-4937

Mailing address

1716 S Phoenix Ave
Tulsa, OK 74107-1850
Phone (918) 561-8306

Other names 1

  • OSU-AJ SOUTHSIDE DERMATOLOGY MUSKOGEE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Oklahoma State University223 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

Locations

333 S 38th St
Ste E
Muskogee, OK 74401
Phone (918) 682-1339

NPI Registry JSON

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

{
    "created_epoch": "1655856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1376274118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 S PHOENIX AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741071850",
            "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": "333 S 38TH ST STE E",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744014937",
            "telephone_number": "918-561-8306",
            "fax_number": "918-561-5747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSU CENTER FOR HEALTH SCIENCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-22",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "POLAK",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF ADMIN/FINANCE",
        "authorized_official_telephone_number": "918-561-8422"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSU-AJ SOUTHSIDE DERMATOLOGY MUSKOGEE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muskogee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; 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.