Provider Demographics
NPI:1174866875
Name:PARKSIDE PSYCHIATRIC HOSPITAL & CLINIC
Entity Type:Organization
Organization Name:PARKSIDE PSYCHIATRIC HOSPITAL & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:918-588-8888
Mailing Address - Street 1:1619 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5410
Mailing Address - Country:US
Mailing Address - Phone:918-588-8888
Mailing Address - Fax:918-588-8859
Practice Address - Street 1:1619 E 13TH ST
Practice Address - Street 2:1620 E. 12TH
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5410
Practice Address - Country:US
Practice Address - Phone:918-588-8888
Practice Address - Fax:918-588-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1437370772Medicaid