Provider Demographics
NPI:1437370772
Name:PARKSIDE, INC.
Entity Type:Organization
Organization Name:PARKSIDE, INC.
Other - Org Name:PARKSIDE INPATIENT HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAUNYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:918-582-2131
Mailing Address - Street 1:1619 EAST 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120
Mailing Address - Country:US
Mailing Address - Phone:918-582-2131
Mailing Address - Fax:
Practice Address - Street 1:1619 EAST 13TH STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5410
Practice Address - Country:US
Practice Address - Phone:918-582-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100738360HMedicaid
OK374021Medicare ID - Type UnspecifiedMEDICARE
OK730703797Medicare ID - Type UnspecifiedMEDICARE