Provider Demographics
NPI:1710985064
Name:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
Entity Type:Organization
Organization Name:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PATIENT FINANCIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLHAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-502-8000
Mailing Address - Street 1:PO BOX 707001
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-7001
Mailing Address - Country:US
Mailing Address - Phone:918-502-8000
Mailing Address - Fax:918-502-8002
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-481-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700380CMedicaid
OK100700380DOtherMEDICAID DVSD
OK100700380NOtherMEDICAID 1500
OK100700380BOtherMEDICAID INPATIENT
OKCC6784OtherMEDICARE RAILROAD
OK========= 74136 0000OtherCHAMPUS
OKCC6784OtherMEDICARE RAILROAD
OKCC6784OtherMEDICARE RAILROAD
OK374020Medicare ID - Type Unspecified
OK========= 74136 0000OtherCHAMPUS