OSU CENTER FOR HEALTH SCIENCES (OSU-AJ MERCY CLINIC ADA) - NPI NUMBER 1053692475

Summary

Provider Name: OSU CENTER FOR HEALTH SCIENCES (OSU-AJ MERCY CLINIC ADA)

NPI Number: 1053692475

Clasification: Clinic/Center (261Q00000X)

Address:
530 N MONTE VISTA ST
SUITE A
ADA, OK
ZIP 74820

Phone Number: (580) 310-9510



Detailed Information

OSU CENTER FOR HEALTH SCIENCES is a clinic/center in Ada, OK. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). The assigned NPI number for this provider is 1053692475 and is registered as an organization entity type.
The provider Is Doing Business As Osu-aj Mercy Clinic Ada.

The provider's business address is:

530 N MONTE VISTA ST
SUITE A
ADA, OK
ZIP 74820-675
Phone: (580) 310-9510

The provider's authorized official is Eric Polak .
The authorized official title is Cfo Osu Physicians and has the following contact phone number (918) 561-8422.

The enumeration date for this NPI number is 8/30/2011 and was last updated on 8/30/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261Q00000X Clinic/Center Yes

NPI Record

No. Field Name Field Value
1 NPI 1053692475
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name OSU CENTER FOR HEALTH SCIENCES
5 Provider Other Organization Name OSU-AJ MERCY CLINIC ADA
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 530 N MONTE VISTA ST
8 Provider Second Line Business Practice Location Address SUITE A
9 Provider Business Practice Location Address City Name ADA
10 Provider Business Practice Location Address State Name OK
11 Provider Business Practice Location Address Postal Code 748204675
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 5803109510
14 Provider Enumeration Date 8/30/2011
15 Last Update Date 8/30/2011
16 Authorized Official Last Name POLAK
17 Authorized Official First Name ERIC
18 Authorized Official Title or Position CFO OSU PHYSICIANS
19 Authorized Official Telephone Number 9185618422
20 Healthcare Provider Taxonomy Code 1 261Q00000X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N

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This page was last updated on: 9/11/2014
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