| NPI | 1871110148 |
|---|---|
| Doing Business As | OSU-AJ PEDIATRIC ENT AT MCBRIDE |
| Entity Type | Organization |
| Authorized Contact | ERIC JOHN POLAK Vice President For Admin/Finance 918-561-8422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2020-07-02 |