NPIMap

Organization Active NPI

Osu MC Professional Services LLC

Doing business as Osu Medical Group Riverside Primary Care

  • Clinic/Center
  • Tulsa, OK
National Provider Identifier
1720417546
Registry record updated Nov 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
OSU MC PROFESSIONAL SERVICES LLC
Doing business as
Osu Medical Group Riverside Primary Care
Practice address
9645 Riverside Pkwy
Suite C
Tulsa, OK 74137-7423
Phone
(918) 561-8306
NPI assigned
Nov 2, 2013
Last updated
Nov 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2013

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

Authorized official

Name
Eric Polak
Title
Cfo
Phone
(918) 561-8422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

9645 Riverside Pkwy
Suite C
Tulsa, OK 74137-7423

Mailing address

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

Other names 1

  • OSU MEDICAL GROUP RIVERSIDE PRIMARY CARE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Osumc Professional Services3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9645 Riverside Pkwy
Ste C
Tulsa, OK 74137
Phone (918) 209-5170

NPI Registry JSON

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383350400000",
    "number": "1720417546",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 RIVERSIDE PKWY",
            "address_2": "SUITE C",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741377423",
            "telephone_number": "918-561-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSU MC PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A",
        "authorized_official_last_name": "POLAK",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CFO",
        "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 MEDICAL GROUP RIVERSIDE PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2013; 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.