Provider Demographics
NPI:1962708461
Name:OU MEDICINE INC.
Entity type:Organization
Organization Name:OU MEDICINE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-738-7943
Mailing Address - Street 1:1200 CHILDRENS AVE STE 7300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-1047
Mailing Address - Fax:405-271-4301
Practice Address - Street 1:1200 CHILDRENS AVE STE 7300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-1047
Practice Address - Fax:405-271-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
OK1-55903336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3726481OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK200021910HMedicaid