NPIMap

Organization Active NPI

Osumc Professional Services LLC

Doing business as OSU Medical Group

  • Family Medicine Physician
  • Okmulgee, OK
National Provider Identifier
1730793696
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OSUMC PROFESSIONAL SERVICES LLC
Doing business as
OSU Medical Group
Practice address
112 W 5TH Street
Okmulgee, OK 74447-0000
Phone
(918) 752-1080
Fax
(918) 752-1081
NPI assigned
Sep 8, 2020
Last updated
Sep 8, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
OSUMC PROFESSIONAL SERVICES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Samantha Kay Overfield
Title
Credentialing Administrator
Phone
(918) 561-5714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

112 W 5TH Street
Okmulgee, OK 74447-0000

Mailing address

2401 Southwest Blvd
Tulsa, OK 74107-2726
Phone (918) 561-5701

Other names 1

  • OSU Medical Group Doing business as

National Provider Directory

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

Other organizations with this tax ID 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1730793696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 SOUTHWEST BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741072726",
            "telephone_number": "918-561-5701",
            "fax_number": "918-561-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W 5TH STREET",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744470000",
            "telephone_number": "918-752-1080",
            "fax_number": "918-752-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSUMC PROFESSIONAL SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OSUMC PROFESSIONAL SERVICES LLC",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "OVERFIELD",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "918-561-5714"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSU Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Okmulgee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.