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 Field Definition 1
1 NPI 1053692475 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name OSU CENTER FOR HEALTH SCIENCES The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name OSU-AJ MERCY CLINIC ADA Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 530 N MONTE VISTA ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE A The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name ADA The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name OK The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 748204675 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 5803109510 The telephone number associated with the location address of the provider being identified.
14 Provider Enumeration Date 8/30/2011 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 8/30/2011 The date that a record was last updated or changed.
16 Authorized Official Last Name POLAK The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name ERIC The first name of the authorized official.
18 Authorized Official Title or Position CFO OSU PHYSICIANS The title or position of the authorized official.
19 Authorized Official Telephone Number 9185618422 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 261Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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