STATE OF OKLAHOMA OSU CENTER FOR HEALTH SCIENCES (NPI# 1588229033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588229033 |
| Entity Type | Organization |
| Organization Name | STATE OF OKLAHOMA OSU CENTER FOR HEALTH SCIENCES |
| Practice Address |
6333 E Skelly Dr Tulsa OK 74135-6106 |
| Mailing Address |
2401 Southwest Blvd Tulsa OK 74107-2726 |
| Practice Telephone | 9185611700 |
| Practice Fax Number | 9185611701 |
| Mailing Telephone | 9185611700 |
| Mailing Fax Number | 9185611701 |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-05-09 |
| Authorized Official Name | ERIC JOHN POLAK (VP/CFO) |
| Authorized Official Telephone | 9185618422 |
| Is Organization Subpart | Y |
| Parent Organization Name | OKLAHOMA STATE UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100757080A | 05 |
| Other Name | Type Code |
|---|---|
| OSU Physicians Addiction Medicine | Doing Business As Name - Organization |
| Street Address |
6333 E SKELLY DR |
| City | TULSA |
| State | OK |
| Zip Code | 74135-6106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053317883 | 12 & 12, Inc. | Substance Abuse Rehabilitation Facility | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2005-06-27 |
| 1720685175 | Jesse Misthaven | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-10-07 |
| 1699372482 | Christine Reynold | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-10-05 |
| 1679185920 | Kacey Ann Cottrell | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-08-18 |
| 1861003931 | Matthew Schane | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-08-12 |
| 1841817368 | Bernadette Bouciquot | Registered Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-30 |
| 1568088011 | Brenda Kay Kuntzelman | Licensed Practical Nurse | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-21 |
| 1023634698 | Kelli Ann Ordorica | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-19 |
| 1215552120 | Amanda Lindsey Spicer | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-16 |
| 1619592672 | Tieraney Candice Rodriguez | Case Manager/Care Coordinator | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2020-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761590 | Dr. Whitney M. Ellsworth, Dpt, Pllc | Physical Therapist | 4185 S Harvard Ave, Suite E-1, Tulsa, OK 74135 | 2020-08-20 |
| 1942839089 | Kimberly Renee Gillens | Student in an Organized Health Care Education/Training Program | 4502 E 41st Street Obgyn Department, Tulsa, OK 74135 | 2020-04-01 |
| 1528525524 | Everest Pain Management | Clinic/Center | 4134 S Harvard Ave Suite B1, Tulsa, OK 74135 | 2019-02-26 |
| 1326524216 | Shelley Deeann Anderson | Technician | 7359 S 68th, Tulsa, OK 74135 | 2018-07-14 |
| 1811489065 | Taylor Diane Spears | Behavioral Analyst | 4835 S Fulton Ave Suite 104, Tulsa, OK 74135 | 2018-06-04 |
| 1225547821 | Heather Nicole Freed | Counselor | 4363 S Harvard Ave, Tulsa, OK 74135 | 2017-09-26 |
| 1306363924 | Danielle Walker | Case Manager/Care Coordinator | 3244 S Lakewood Ave Apt 4e, Tulsa, OK 74135 | 2017-08-24 |
| 1346766078 | Angels Place | Day Training, Developmentally Disabled Services | 3919 S. Oswego Avenue, Tulsa, OK 74135 | 2017-08-15 |
| 1659800019 | Welena-phay Kamamma Boren | Counselor | 4636 S Harvard Avenue, Tulsa, OK 74135 | 2017-06-08 |
| 1346774197 | Brandie Herren | Registered Nurse | 6333 E Skelly Drive, Tulsa, OK 74135 | 2017-04-19 |
| Find all providers in zip 74135 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164070314 | Lowell James Robertson | Psychiatry & Neurology | 1111 W 17th St, Tulsa, OK 74107-1886 | 2019-08-30 |
| 1467659953 | Samuel Gene Martin | Psychiatry & Neurology | 6333 E Skelly Dr, Tulsa, OK 74135-6106 | 2007-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497223846 | Mind and Body Medical Clinic | Psychiatry & Neurology | 2216 Nw 164th St Ste A, Edmond, OK 73013-9078 | 2018-11-04 |
| 1306134929 | Kimberlee Van Wilson | Psychiatry & Neurology | 4851 Integris Parkway, Edmond, OK 73034 | 2011-07-17 |
| 1316124605 | Jorg Johannes Pahl | Psychiatry & Neurology | 3909 N Classen Blvd Ste 200, Oklahoma City, OK 73118-2650 | 2008-01-29 |
| 1437683729 | F Clark Sauls, Md | Psychiatry & Neurology | 723 W Randolph Ave, Suite 6, Enid, OK 73701-3826 | 2017-04-13 |
| 1184981144 | Dustin O'leath Hayes | Psychiatry & Neurology | 817 S Elm Pl, Suite C, Broken Arrow, OK 74012-5369 | 2012-04-16 |
| 1942488986 | Jane Phillips Specialty Physicians | Psychiatry & Neurology | 226 Se Debell Ave, Bldg B, Bartlesville, OK 74006-2343 | 2008-02-01 |
| 1801966338 | Gayathri Dasharathy | Psychiatry & Neurology | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2006-11-09 |
| 1831281070 | Nicasio S Gutierrez Jr. | Psychiatry & Neurology | 909 Alameda St, Norman, OK 73071-5229 | 2006-09-28 |
| 1528168721 | Gita - Pujari II | Psychiatry & Neurology | 921 Ne 13th St, 116c, Oklahoma City, OK 73104-5007 | 2006-09-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.