# LAKESIDE WOMEN'S CENTER OF OKLAHOMA CITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKESIDE WOMEN'S CENTER OF OKLAHOMA CITY, LLC
- **Other names:** Lakeside Physician Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1811295108
- **Legal business name:** LAKESIDE WOMEN'S CENTER OF OKLAHOMA CITY, LLC
- **Authorized official:** DARLA MCCALLISTER (CFO)
- **Authorized official phone:** (405) 936-1554

## Contact information

- **Practice address:** 11200 N PORTLAND AVE, OKLAHOMA CITY, OK 73120-5045
- **Practice address phone:** (405) 936-1500
- **Practice address fax:** (405) 418-0524
- **Mailing address:** PO BOX 8387, BELFAST, ME 04915-8300
- **Mailing address phone:** (405) 936-1577
- **Mailing address fax:** (866) 354-4053

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/10/2011
- **Last updated:** 02/24/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000370199001 | BCBS | OK |
| 05 | — | 100745350C | — | OK |