Provider Demographics
NPI:1639170699
Name:LAKESIDE WOMEN'S HOSPITAL, LLC
Entity Type:Organization
Organization Name:LAKESIDE WOMEN'S HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-951-2737
Mailing Address - Street 1:11200 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5045
Mailing Address - Country:US
Mailing Address - Phone:405-986-1500
Mailing Address - Fax:405-936-1579
Practice Address - Street 1:11200 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5045
Practice Address - Country:US
Practice Address - Phone:405-986-1500
Practice Address - Fax:405-936-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2339282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000370199001OtherBCBS
OK100745350BMedicaid
OK100745350AMedicaid
OK370199Medicare Oscar/Certification
OK100745350BMedicaid