Provider Demographics
NPI:1154598605
Name:OKLAHOMA STATE UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:OKLAHOMA STATE UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXOPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-599-5920
Mailing Address - Street 1:1229 W 112TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2037
Mailing Address - Country:US
Mailing Address - Phone:918-518-6346
Mailing Address - Fax:
Practice Address - Street 1:744 W 9TH ST # H410
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9020
Practice Address - Country:US
Practice Address - Phone:918-599-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital