| Oklahoma State University | |
|
170 Athletics Center Stillwater OK 74078-0001 | |
| (405) 744-5430 | |
| (405) 744-4945 |
| Full Name | Oklahoma State University |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 170 Athletics Center, Stillwater, Oklahoma |
| Authorized Official Name and Position | Eric John Polak (VP ADMINISTRATIVE AFFAIRS) |
| Authorized Official Contact | 9185618422 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oklahoma State University 5310 E 31st St Fl 13 Tulsa OK 74135-5018 Ph: (918) 561-5701 | Oklahoma State University 170 Athletics Center Stillwater OK 74078-0001 Ph: (405) 744-5430 |
| NPI Number | 1245909308 |
|---|---|
| Provider Enumeration Date | 09/10/2021 |
| Last Update Date | 09/10/2021 |
| Certification Date | 08/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245909308 | NPI | - | NPPES |
| 100757080A | Medicaid | OK | |
| 684577 | Other | OK | MEDICARE |
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